BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® COMFORT CURVE TEST STRIPS

    MDR report key: 2211176 · Received August 15, 2011

    Report

    Report Number
    1823260-2011-04336
    Event Type
    Malfunction
    Date Received
    August 15, 2011
    Date of Event
    July 28, 2011
    Report Date
    September 29, 2011
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K010362
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WA, 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

    REPORTER ALLEGED OBTAINING THE RESULTS OF 300 MG/DL AND 120 MG/DL BACK TO BACK WITHIN 10 MINUTES ON THE ADVANTAGE SYSTEM. NO 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 ® COMFORT CURVE TEST STRIPS BLOOD GLUCOSE MONITORING TEST STRIPS LFR ROCHE DIAGNOSTICS NA 551560

    Patients

    Seq Age Sex Outcome Treatment
    1 059 YR OXYGEN TANK| GLARGINE HUMAN INSULIN| AMLODIPINE BESYLATE (DAILY)| FORMOTEROL FUMARATE| ALBUTEROL INHALER| "MOMETASONE TWISTALAR"| CYCLOBENZAPRINE HYDROCHLORIDE (DAILY)| SERTRALINE HYDROCHLORIDE (DAILY)| "HYDROCODONE ANZEMADEPHINE"| MORPHINE SULFATE| SIMVASTATIN (DAILY)| METFORMIN| HYDROCHLOROTHIAZIDE