BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® MULTICLIX

    MDR report key: 1980811 · Received February 7, 2011

    Report

    Report Number
    1823260-2011-00666
    Event Type
    Malfunction
    Date Received
    February 7, 2011
    Date of Event
    January 20, 2011
    Report Date
    February 28, 2011
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    FMK
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NL
    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 REPORTS LANCET PROTRUDED BEYOND THE END CAP OF THE MULTICLIX DEVICE AND FELL OUT OF THE DEVICE. NO ACCIDENTAL NEEDLE STICK OCCURRED. NO ADVERSE EVENT REPORTED. REQUESTED RETURN OF SUSPECT DEVICE HOWEVER CALLER HAS DISCARDED THE SYSTEM; REPLACEMENT WAS SENT.

    Description of Event or Problem · 1

    CALLER REPORTS LANCET PROTRUDED BEYOND THE END CAP OF THE MULTICLIX DEVICE AND FELL OUT OF THE DEVICE. NO ACCIDENTAL NEEDLE STICK OCCURRED. NO ADVERSE EVENT REPORTED. REQUESTED RETURN OF SUSPECT DEVICE; REPLACEMENT WAS SENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACCU-CHEK ® MULTICLIX LANCET DEVICE FMK ROCHE DIAGNOSTICS NA WIT093

    Patients

    Seq Age Sex Outcome Treatment
    1