BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® COMPACT TEST DRUM

    MDR report key: 1981721 · Received February 8, 2011

    Report

    Report Number
    1823260-2011-00690
    Event Type
    Malfunction
    Date Received
    February 8, 2011
    Date of Event
    January 24, 2011
    Report Date
    March 16, 2011
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K031755
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    PATIENT

    Narratives

    Additional Manufacturer Narrative · 1

    IT WAS UNKNOWN IF THE INITIAL REPORTER SENT REPORT TO THE FDA.

    Description of Event or Problem · 1

    CUSTOMER REPORTEDLY RECEIVED THE FOLLOWING RESULTS ON THE COMPACT PLUS SYSTEM WITHIN 10 MINUTES: 169 MG/DL AND 69 MG/DL. CUSTOMER WAS FEELING WEAK AND SHAKY WITH THE READING OF 69 MG/DL, SO SHE TOOK ANOTHER READING. CUSTOMER WAS ABLE TO SELF-TREAT WITH TOAST, PEANUT BUTTER, AND 2 ORANGES. NO ADVERSE EVENT REPORTED. REQUESTED RETURN OF SUSPECT DEVICE AND REPLACEMENT WAS SENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACCU-CHEK ® COMPACT TEST DRUM BLOOD GLUCOSE MONITORING TEST STRIPS LFR ROCHE DIAGNOSTICS NA 20729341

    Patients

    Seq Age Sex Outcome Treatment
    1 065 YR OMEPRAZOLE| NEBULIZER| JANUVIA| VITAMIN E 2X DAILY| SYNTHROID| ABILIFY| ACTOS| METFORMIN| VITAMIN D| TRICOR| ASA| EFFEXOR 2X DAILY| LISINOPRIL 2X DAILY| LEVOTHYROXINE 2X DAILY| TRAZODONE| SIMVASTATIN| MIRTAZANINE