FDA Adverse Event Injury Summary report: N

OT ULTRAMINI METER

MDR report key: 1969295 · Received January 24, 2011

Report

Report Number
2939301-2011-00764
Event Type
Injury
Date Received
January 24, 2011
Report Date
January 14, 2011
Manufacturer
LIFESCAN INC.
Product Code
NBW
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
TN, US
Reporter Occupation
PATIENT

Narratives

Additional Manufacturer Narrative · 1

THE 510(K) # IS K061118.

Description of Event or Problem · 1

ON (B)(6), 2011, THE LAY USER/ PATIENT CONTACTED LIFESCAN (LFS) ALLEGING HER ONETOUCH ULTRAMINI METER READ INACCURATELY HIGH COMPARED TO HER EXPECTED RESULTS. THE MEDICAL SURVEILLANCE SPECIALIST (MSS) WAS UNABLE TO REACH THE LAY USER/PATIENT FOR FOLLOW-UP QUESTIONS. THE FOLLOWING COMPLAINT WAS CLASSIFIED BASED ON INFORMATION OBTAINED FROM LIFESCAN CUSTOMER SERVICE. THE ALLEGED ISSUE BEGAN ABOUT 2 MONTHS AGO PRIOR TO CONTACTING LFS. THE PATIENT REPORTED BLOOD GLUCOSE RESULTS OF '182, 160, 190, 179 AND 213 MG/DL' WITH THE SUBJECT METER. THE CUSTOMER CARE ADVOCATE (CCA) WAS ADVISED THE PATIENT MANAGES HER DIABETES WITH AMARYL PILLS (AMOUNT NOT SPECIFIED). THE PATIENT STATED SHE INCREASED HER USUAL DOSE OF AMARYL (4 MG). AT AN UNSPECIFIED TIME, THE PATIENT CLAIMED SHE FELT SYMPTOMS OF NAUSEATED, SHAKY, SWEATY AND WEAK. THE PATIENT DID NOT SPECIFY ANY MEDICAL TREATMENT. AT THE TIME OF TROUBLESHOOTING, THE CCA NOTED THE UNIT OF MEASUREMENT WAS SET CORRECTLY. THE CCA WALKED THE PATIENT THROUGH CORRECTLY CODING THE METER TO MATCH THE TEST STRIP. THE PATIENT DID NOT HAVE CONTROL SOLUTION TO TEST THE SUBJECT METER. THIS COMPLAINT IS BEING REPORTED BECAUSE THE PATIENT REPORTEDLY DEVELOPED SYMPTOMS SUGGESTIVE OF A SERIOUS INJURY AFTER THE ALLEGED METER ISSUE BEGAN.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 OT ULTRAMINI METER GLUCOSE MONITORING SYS/KIT NBW LIFESCAN INC. 3068171

Patients

Seq Age Sex Outcome Treatment
1 63 YR Life Threatening