BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® COMFORT CURVE TEST STRIPS

    MDR report key: 2011866 · Received March 9, 2011

    Report

    Report Number
    1823260-2011-01272
    Event Type
    Malfunction
    Date Received
    March 9, 2011
    Date of Event
    February 24, 2011
    Report Date
    March 24, 2011
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K010362
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, 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 ADVANTAGE SYSTEM WITHIN 10 MINUTES: 150 MG/DL, 195 MG/DL, 294 MG/DL, 300 MG/DL, 409 MG/DL, 245 MG/DL, AND 175 MG/DL. NO ACTIONS TAKEN BASED ON DEVICE RESULTS. 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 ® COMFORT CURVE TEST STRIPS BLOOD GLUCOSE MONITORING TEST STRIPS LFR ROCHE DIAGNOSTICS NA 551419

    Patients

    Seq Age Sex Outcome Treatment
    1 072 YR METFORMIN| LISINOPRIL| CLONIDINE| CARVEDILOL| CITALOPRAM| SIMVASTATIN| FENOFIBRATE| ASPIRIN| GLIPIZIDE