BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® AVIVA PLUS TEST STRIPS

    MDR report key: 3033008 · Received April 3, 2013

    Report

    Report Number
    1823260-2013-02010
    Event Type
    Malfunction
    Date Received
    April 3, 2013
    Date of Event
    February 20, 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
    WV, 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 287 MG/DL AND 109 MG/DL WITHIN 10 MINUTES. CALLER REPORTED A SEPARATE COMPARISON ON THE SAME SYSTEM OF 341 MG/DL AND 104 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
    135973 ACCU-CHEK ® AVIVA PLUS TEST STRIPS BLOOD GLUCOSE MONITORING TEST STRIPS LFR ROCHE DIAGNOSTICS NA 491351

    Patients

    Seq Age Sex Outcome Treatment
    1 44 YR Male ALBUTEROL| ATROVENT| BENICAR 1 X DAY| BENZTROPINE MESYLATE 1 X DAY| DIVALPROEX 4 X DAY| GABAPENTIN 1 X DAY| HALOPERIDOL 1 X DAY| HYDROCHLOROTHIAZIDE 1 X DAY| KLONOPIN 3 X DAY| METFORMIN| NOVOLIN| ROSUVASTATIN 1 X DAY| VIAGRA| ATROVENT| KLONOPIN 3 X DAY| ALBUTEROL| BENZTROPINE MESYLATE 1 X DAY| GABAPENTIN 1 X DAY| VIAGRA| DIVALPROEX 4 X DAY| ROSUVASTATIN 1 X DAY| BENICAR 1 X DAY| METFORMIN| HYDROCHLOROTHIAZIDE 1 X DAY| NOVOLIN| HALOPERIDOL 1 X DAY