BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® COMPACT TEST DRUM

    MDR report key: 2220350 · Received August 23, 2011

    Report

    Report Number
    1823260-2011-04472
    Event Type
    Malfunction
    Date Received
    August 23, 2011
    Date of Event
    July 28, 2011
    Report Date
    September 28, 2011
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K031755
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KY, 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: 47 MG/DL AND 500 MG/DL. CUSTOMER WAS EXPERIENCING HYPOGLYCEMIC SYMPTOMS OF SHAKINESS AND WEAKNESS AT THE TIME OF THE 47 MG/DL READING. CUSTOMER DRANK A GLASS OF MILK AND RETESTED AT 500 MG/DL. CUSTOMER FELT BETTER AFTER DRINKING THE MILK. 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 20726744

    Patients

    Seq Age Sex Outcome Treatment
    1 072 YR ASPIRIN| LASIX| HUMALOG| METOPROLOL| HUMULIN| LIPITOR