BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® COMPACT TEST DRUM

    MDR report key: 2173500 · Received July 23, 2011

    Report

    Report Number
    1823260-2011-03927
    Event Type
    Malfunction
    Date Received
    July 23, 2011
    Date of Event
    July 11, 2011
    Report Date
    August 15, 2011
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    THE EVENT OCCURRED IN (B)(6).

    Description of Event or Problem · 1

    REPORTER ALLEGED OBTAINING THE RESULTS OF 28.2 MMOL/L, 12.4 MMOL/L AND 11.7 MMOL/L BACK TO BACK WITHIN 10 MINUTES ON THE COMPACT PLUS SYSTEM. REPORTER SELF-TREATED WITH 5 UNITS OF HUMALOG BASED ON THE LAST TWO READINGS AND THEN ATE. NO OTHER ACTIONS WERE REPORTED TAKEN OR TREATMENT RECEIVED. NO ADVERSE EVENT REPORTED. A REQUEST WAS MADE FOR THE RETURN OF THE AFFECTED PRODUCT.

    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 20729149

    Patients

    Seq Age Sex Outcome Treatment
    1 078 YR LANTUS (DAILY)| HUMALOG (SIDING SCALE)