BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COAGUCHEK S SYSTEM

    MDR report key: 1780139 · Received September 21, 2007

    Report

    Report Number
    1823260-2007-08285
    Event Type
    Malfunction
    Date Received
    September 21, 2007
    Date of Event
    September 6, 2007
    Report Date
    September 21, 2007
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    JPA
    PMA / PMN Number
    K974569
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    CALLER REPORTS THAT PATIENT TESTED 2.8 INR AND 1.6 INR ON THE COAGUCHEK S SYSTEM DURING DUPLICATE TESTING. NO TREATMENT INFORMATION WAS PROVIDED. NO ADVERSE EVENT REPORTED. REQUESTED RETURN OF SUSPECT SYSTEM AND REPLACEMENT SENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COAGUCHEK S SYSTEM PROTHROMBIN TIME TEST STRIPS - JPA JPA ROCHE DIAGNOSTICS 589A-G9

    Patients

    Seq Age Sex Outcome Treatment
    1 53 YR COUMADIN