BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK MOBILE TEST STRIPS

    MDR report key: 1952687 · Received January 7, 2011

    Report

    Report Number
    1823260-2011-00108
    Event Type
    Malfunction
    Date Received
    January 7, 2011
    Date of Event
    January 4, 2011
    Report Date
    February 28, 2011
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NO
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    THE EVENT OCCURRED IN (B)(6).

    Description of Event or Problem · 1

    CALLER REPORTED MOBILE BLOOD GLUCOSE RESULTS OF 4.0 MMOL/L, 8.9 MMOL/L, 4.2 MMOL/L, AND A COMPACT PLUS RESULT OF 5.1 MMOL/L WITHIN 10 MINUTES. REPORTED NO ADVERSE EVENT RELATIVE TO DISCREPANCY. NO COMPACT PLUS SYSTEM INFORMATION WAS REPORTED. A REQUEST WAS MADE FOR THE RETURN OF THE METER AND STRIPS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACCU-CHEK MOBILE TEST STRIPS BLOOD GLUCOSE MONITORING TEST STRIPS LFR ROCHE DIAGNOSTICS NA 277070

    Patients

    Seq Age Sex Outcome Treatment
    1 030 YR INSULIN 1XDAY