BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK MOBILE TEST STRIPS

    MDR report key: 1955380 · Received January 10, 2011

    Report

    Report Number
    1823260-2011-00155
    Event Type
    Malfunction
    Date Received
    January 10, 2011
    Date of Event
    December 17, 2010
    Report Date
    January 18, 2011
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IT
    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 SYSTEM BLOOD GLUCOSE RESULTS OF 399 MMOL/L AND NANO SYSTEM RESULT OF 188 MMOL/L WITHIN 10 MINUTES. REPORTED FROM ANOTHER DAY MOBILE SYSTEM BLOOD GLUCOSE RESULTS OF 454 MMOL/L AND NANO SYSTEM RESULT OF 189 MMOL/L WITHIN 10 MINUTES. NO NANO SYSTEM INFORMATION WAS PROVIDED. REPORTED NO ADVERSE EVENT RELATIVE TO DISCREPANCY. A REQUEST WAS MADE FOR THE RETURN OF THE METER AND STRIPS, REPLACEMENT SENT.

    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 277047

    Patients

    Seq Age Sex Outcome Treatment
    1 050 YR LAPROVEL| TAREGA| PROVISACORT| APROVEL| "CIMPLAI"| TAREGA