BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    OT PING METER

    MDR report key: 2905807 · Received January 9, 2013

    Report

    Report Number
    3008382007-2013-00553
    Event Type
    Malfunction
    Date Received
    January 9, 2013
    Report Date
    December 21, 2012
    Manufacturer
    LIFESCAN EUROPE, A DIVISION OF CILAG GMBH INTL
    Product Code
    NBW
    PMA / PMN Number
    K082590
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MO, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4): THE PRIMARY COMPLAINT WAS NOT CONFIRMED, HOWEVER, A SECONDARY ISSUE WAS NOTED WHERE THE BATTERY WAS FOUND TO BE LOW/DEAD. IF LIFESCAN OBTAINS ADDITIONAL INFORMATION REGARDING THIS COMPLAINT, A FOLLOW UP REPORT WILL BE SUBMITTED. AT THIS TIME, LIFESCAN CONSIDERS THIS MATTER CLOSED.

    Description of Event or Problem · 1

    ON (B)(6) 2012, THE REPORTER CONTACTED LIFESCAN USA, ALLEGING THAT AFTER TAKING THE BATTERY OUT REINSERTING IT BACK IN, THE METER TURNED ON WITH A BLACK SCREEN. IT THEN DISPLAYED BLACK LINES ACROSS THE SCREEN AND BEEPED LIKE A "VIDEO GAME." THIS COMPLAINT IS BEING REPORTED BECAUSE THE REPORTED ISSUE WAS NOT RESOLVED WITH TROUBLESHOOTING. THERE WAS NO INDICATION THAT THE PRODUCT CAUSED OR CONTRIBUTED TO AN ADVERSE EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    11361 OT PING METER GLUCOSE MONITORING SYS/KIT NBW LIFESCAN EUROPE, A DIVISION OF CILAG GMBH INTL 3261454

    Patients

    Seq Age Sex Outcome Treatment
    1 31 YR