BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PRECISION XTRA

    MDR report key: 1972026 · Received January 27, 2011

    Report

    Report Number
    2954323-2011-01218
    Event Type
    Malfunction
    Date Received
    January 27, 2011
    Date of Event
    December 27, 2010
    Report Date
    January 27, 2011
    Product Code
    NBW
    Removal / Correction Number
    ADC FA1197-2010
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    RETAIN SAMPLES OF PRECISION TEST STRIP LOTS MANUFACTURED WITH HOT-MELT GLUE BATCHES EXHIBITED LOWER THAN EXPECTED READINGS ON CONTINUOUS STORAGE AFTER NINE MONTHS AT 30 DEGREES CELSIUS DURING ROUTINE STABILITY PERFORMANCE TESTING. THIS STABILITY ISSUE COULD LEAD TO THE GENERATION OF INCORRECTLY DEPRESSED BLOOD GLUCOSE RESULTS AND THESE ERRONEOUS RESULTS MAY BE IN THE "C", "D" OR "E" ZONES OF PARKES ERROR GRID, AND AS SUCH, HAVE THE POTENTIAL TO BE CLINICALLY SIGNIFICANT. THE PRIMARY CAUSE HAS BEEN IDENTIFIED TO BE BATCH TO BATCH GLUE VARIABILITY. THE FDA HAS BEEN INFORMED OF THE FIELD ACTION PER 21CFR806 (FIELD ACTION REFERENCE NUMBER 2954323-12/22/10-001-R). ALL AFFECTED CONSIGNEES WERE NOTIFIED BY LETTER BEGINNING DECEMBER 22, 2010.

    Description of Event or Problem · 1

    CUSTOMER'S MOTHER REPORTED CUSTOMER RECEIVED READINGS OF 70 MG/DL ON (B)(6) 2010 AND 69 MG/DL ON (B)(6) 2010, WHICH WERE LOWER THAN HE FELT. SHE FURTHER REPORTED HE SUBSEQUENTLY EXPERIENCED TREMULOUSNESS, HEADACHES AND HUNGER. NO THIRD-PARTY EMERGENT INTERVENTION WAS REPORTED. CUSTOMER SELF-TREATED BY DRINKING JUICE AND EATING CRACKERS. IT WAS ADDITIONALLY REPORTED THE CUSTOMER HAD BEEN USING TEST STRIPS RELATED TO AN ON-GOING FIELD ACTION FOR ABBOTT'S PRECISION FAMILY TEST STRIPS. THE READINGS THE CUSTOMER RECEIVED ARE CONSISTENT WITH THE SYMPTOMS EXPERIENCED. THERE WAS NO REPORT OF DEATH, SERIOUS INJURY OR MISTREATMENT ASSOCIATED WITH THIS COMPLAINT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PRECISION XTRA BLOOD GLUCOSE MONITORING SYSTEM NBW 45001A798

    Patients

    Seq Age Sex Outcome Treatment
    1