BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® AVIVA PLUS TEST STRIPS

    MDR report key: 3013527 · Received March 20, 2013

    Report

    Report Number
    1823260-2013-01708
    Event Type
    Malfunction
    Date Received
    March 20, 2013
    Date of Event
    February 26, 2013
    Report Date
    July 29, 2025
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    K101299
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    PATIENT
    Health Professional
    N

    Narratives

    Additional Manufacturer Narrative · 1

    IT WAS UNKNOWN IF THE INITIAL REPORTER SENT REPORT TO THE FDA. MEDWATCH WITH (B)(6) IS AVIVA SYSTEM 1, MEDWATCH WITH (B)(6) IS AVIVA SYSTEM 2.

    Description of Event or Problem · 1

    CALLER REPORTED BLOOD GLUCOSE RESULTS. AVIVA SYSTEM 1: 70 MG/DL AT 04:45 PM 38 MG/DL AT 04:46 PM AVIVA SYSTEM 2: 78 MG/DL AT 04:56 PM 33 MG/DL AT 05:03 PM NO ADVERSE EVENT WAS REPORTED. A REQUEST WAS MADE FOR THE RETURN OF THE STRIPS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    115334 ACCU-CHEK ® AVIVA PLUS TEST STRIPS BLOOD GLUCOSE MONITORING TEST STRIPS LFR ROCHE DIAGNOSTICS NA 491374

    Patients

    Seq Age Sex Outcome Treatment
    1 51 YR Female CAYENNE PEPPER| GINGER| HAWTHORN BERRY| HEART STENT| HUMALOG| LANTUS| METOPROLOL 1XDAY| OXYCODONE| HAWTHORN BERRY| HEART STENT| CAYENNE PEPPER| LANTUS| OXYCODONE| GINGER| HUMALOG| METOPROLOL 1XDAY