BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® COMPACT TEST DRUM

    MDR report key: 2040266 · Received April 5, 2011

    Report

    Report Number
    1823260-2011-01899
    Event Type
    Malfunction
    Date Received
    April 5, 2011
    Date of Event
    March 30, 2011
    Report Date
    April 20, 2011
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K031755
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    PHARMACIST

    Narratives

    Additional Manufacturer Narrative · 1

    IT WAS UNKNOWN IF THE INITIAL REPORTER SENT REPORT TO THE FDA. CUSTOMER WAS UNSURE WHICH STRIP LOT PRODUCED THE DISCREPANT RESULTS. REFERENCE MEDWATCH REPORT WITH PATIENT IDENTIFIER (B)(6) FOR THE ADDITIONAL SUSPECT DEVICE USED.

    Description of Event or Problem · 1

    CUSTOMER REPORTEDLY RECEIVED RESULTS OF 179 MG/DL AND 88 MG/DL WITHIN 10 MINUTES ON THE COMPACT PLUS SYSTEM. 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 ® COMPACT TEST DRUM BLOOD GLUCOSE MONITORING TEST STRIPS LFR ROCHE DIAGNOSTICS NA 20729041

    Patients

    Seq Age Sex Outcome Treatment
    1 068 YR MULTIVITAMIN W/IRON 1/DAY| HCTZ| METFORMIN| COQ10| POTASSIUM GLUTAMATE| LUTEIN| FLAXSEED OIL| GLUCOSAMINE CHONDROITIN| VITAMIN C| FUROSEMIDE| MELOXICAM| LIPITOR| GLIMEPIRIDE| BLOOD PRESSURE MACHINE