BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® AVIVA TEST STRIPS

    MDR report key: 1942392 · Received December 30, 2010

    Report

    Report Number
    1823260-2010-07763
    Event Type
    Malfunction
    Date Received
    December 30, 2010
    Date of Event
    December 24, 2010
    Report Date
    January 27, 2011
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K043474
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    PATIENT

    Narratives

    Additional Manufacturer Narrative · 1

    THIS MEDWATCH IS FOR THE AVIVA METER. (B)(4).

    Description of Event or Problem · 1

    CUSTOMER ALLEGEDLY RECEIVED THE FOLLOWING RESULTS, WITH TWO DIFFERENT ROCHE METERS, WITHIN 10 MINUTES: 119 MG/DL (AVIVA) AND 54 MG/DL (COMPACT PLUS). NO ACTIONS TAKEN BASED ON DEVICE RESULTS. NO ADVERSE EVENT REPORTED. REVIEW OF STORAGE, HANDLING, DOSING, AND TECHNIQUE WAS PERFORMED # ALL ACCEPTABLE. REQUESTED RETURN OF SUSPECT DEVICE AND REPLACEMENT WAS SENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACCU-CHEK ® AVIVA TEST STRIPS BLOOD GLUCOSE MONITORING TEST STRIPS LFR ROCHE DIAGNOSTICS NA 302995

    Patients

    Seq Age Sex Outcome Treatment
    1 061 YR METFORMIN| GLIPIZIDE| LANTUS