BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® AVIVA PLUS TEST STRIPS

    MDR report key: 2923973 · Received January 22, 2013

    Report

    Report Number
    1823260-2013-00364
    Event Type
    Malfunction
    Date Received
    January 22, 2013
    Date of Event
    December 21, 2012
    Report Date
    July 22, 2025
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K101299
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NH, US
    Reporter Occupation
    PATIENT FAMILY MEMBER OR FRIEND
    Health Professional
    N

    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 AVIVA SYSTEM WITHIN 10 MINUTES: 150 MG/DL AND 350 MG/DL. CUSTOMER'S TEETH WERE CLENCHED AT THIS TIME WHICH ARE SYMPTOMS OF LOW BLOOD SUGAR FOR THE CUSTOMER. WIFE CALLED PARAMEDICS WHO ARRIVED 20 MINUTES LATER AND TESTED THE CUSTOMER ON THEIR DEVICE AT 28 MG/DL. CUSTOMER WAS TREATED WITH AN UNSPECIFIED SOLUTION VIA IV. CUSTOMER ALSO ATE AN ENGLISH MUFFIN WITH PEANUT BUTTER ON IT. HE WAS NOT TAKEN TO THE HOSPITAL AND RECOVERED FULLY THAT EVENING. REQUESTED RETURN OF SUSPECT DEVICE AND STRIPS, AND REPLACEMENT WAS SENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    30582 ACCU-CHEK ® AVIVA PLUS TEST STRIPS BLOOD GLUCOSE MONITORING TEST STRIPS LFR ROCHE DIAGNOSTICS NA ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1 53 YR Male CELEXA| CRESTOR| HUMALOG QUICKPEN - WITH MEALS| LANTUS- 1X A DAY| LOMOTIL| LANTUS- 1X A DAY| LOMOTIL| CRESTOR| HUMALOG QUICKPEN - WITH MEALS| CELEXA