BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® AVIVA PLUS TEST STRIPS

    MDR report key: 3030627 · Received April 2, 2013

    Report

    Report Number
    1823260-2013-01970
    Event Type
    Malfunction
    Date Received
    April 2, 2013
    Date of Event
    March 6, 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
    PA, US
    Reporter Occupation
    PATIENT
    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

    CALLER REPORTED AVIVA SYSTEM BLOOD GLUCOSE RESULTS OF 266 MG/DL, 114 MG/DL, AND 149 MG/DL WITHIN 10 MINUTES. NO ADVERSE EVENT WAS REPORTED. A REQUEST WAS MADE FOR THE RETURN OF THE METER AND STRIPS, REPLACEMENT SENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    134653 ACCU-CHEK ® AVIVA PLUS TEST STRIPS BLOOD GLUCOSE MONITORING TEST STRIPS LFR ROCHE DIAGNOSTICS NA 491319

    Patients

    Seq Age Sex Outcome Treatment
    1 78 YR Male ARTIFICIAL HEART VALVE| ATENOLOL| B-12 SHOTS| BLOOD PRESSURE CUP| COUMADIN| FISH OIL| FLUDROCORTISONE ACETATE| FOLIC ACID| GEMFIBROZIL| HUMULIN 70/30| LYRICA| PROSCAR| TEMAZEPAM| VANTEC - IMPLANT FOR PROSTATE| VITAMIN B-12| VITAMIN D-1000| ZETIA| ZETIA| GEMFIBROZIL| PROSCAR| TEMAZEPAM| VANTEC - IMPLANT FOR PROSTATE| HUMULIN 70/30| ATENOLOL| FOLIC ACID| VITAMIN D-1000| LYRICA| FLUDROCORTISONE ACETATE| BLOOD PRESSURE CUP| ARTIFICIAL HEART VALVE| FISH OIL| COUMADIN| VITAMIN B-12| B-12 SHOTS