BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® MULTICLIX

    MDR report key: 1883848 · Received October 27, 2010

    Report

    Report Number
    1823260-2010-06378
    Event Type
    Malfunction
    Date Received
    October 27, 2010
    Date of Event
    October 22, 2010
    Report Date
    November 29, 2010
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    FMK
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NL
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    THE EVENT OCCURRED IN (B)(6).

    Description of Event or Problem · 1

    MANUFACTURER'S FIRST LEVEL INVESTIGATIONAL UNIT CONFIRMED THE LANCET PROTRUDES BEYOND THE END CAP OF THE MULTICLIX DEVICE AFTER FIRING. SUSPECT DEVICE HAS BEEN RETURNED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACCU-CHEK ® MULTICLIX LANCET DEVICE FMK ROCHE DIAGNOSTICS NA GWX014

    Patients

    Seq Age Sex Outcome Treatment
    1