FDA Adverse Event Injury Summary report: N

OT ULTRA2 METER

MDR report key: 3131790 · Received May 29, 2013

Report

Report Number
3008382007-2013-13170
Event Type
Injury
Date Received
May 29, 2013
Report Date
May 1, 2013
Manufacturer
LIFESCAN EUROPE, A DIVISION OF CILAG GMBH INTL
Product Code
NBW
PMA / PMN Number
K110637
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
MA, US
Reporter Occupation
HEALTH PROFESSIONAL

Narratives

Description of Event or Problem · 1

ON (B)(6) 2013, THE LAY USER/REPORTER CONTACTED LIFESCAN (LFS) ON BEHALF OF THE PATIENT ALLEGING THE PATIENT¿S ONETOUCH ULTRA2 METER WAS DISPLAYING INACCURATELY HIGH READINGS COMPARED TO HER FEELINGS OR NORMAL RESULTS. THE MEDICAL SURVEILLANCE SPECIALIST (MSS) WAS UNABLE TO FOLLOW UP WITH THE PATIENT OR REPORTER FOR ADDITIONAL INFORMATION. THE COMPLAINT WAS CLASSIFIED BASED ON THE CUSTOMER CARE ADVOCATE (CCA) DOCUMENTATION. THE REPORTER STATED, THE ALLEGED ISSUE FIRST OCCURRED ¿A FEW WEEKS¿ PRIOR TO CONTACTING LFS. THE REPORTER STATED OBTAINING READINGS OF ¿276MG/DL.¿ THE REPORTER STATED, THE PATIENT USES A COMBINATION OF MEDICATIONS INCLUDING METFORMIN, 50MG IN THE MORNING AND LANTUS 12 UNITS IN THE EVENING. THE REPORTER STATED, THE PATIENT DID NOT MAKE ANY CHANGES TO HER USUAL DIET, ACTIVITY LEVEL OR MEDICATIONS ON THE DAY OF THE ALLEGED ISSUE. THE REPORTER STATED, THE PATIENT DID NOT DEVELOP ANY SYMPTOMS ON THE DAY OF THE ALLEGED ISSUE. THE REPORTER STATED ON (B)(6) 2013 IN THE AFTERNOON, THE PATIENT WAS TAKEN TO THE EMERGENCY ROOM (ER) AND WAS GIVEN SOMETHING TO EAT OR DRINK AS TREATMENT. THE REPORTER WAS UNABLE TO STATE WHAT READINGS WERE OBTAINED AT THE HOSPITAL. AT THE TIME OF TROUBLESHOOTING, THE CCA CONFIRMED THE SUBJECT METER WAS IN THE CORRECT UNIT OF MEASUREMENT AT THE TIME OF TESTING AND THE TEST STRIPS WERE IN GOOD CONDITION. HOWEVER WHEN A CONTROL SOLUTION TEST WAS RUN, THE RESULT WAS WITHIN THE RECOMMENDED RANGE. REPLACEMENT PRODUCTS WERE SENT TO THE PATIENT. THIS COMPLAINT IS BEING REPORTED BECAUSE, THE REPORTER CLAIMS DUE TO THE ALLEGED ISSUE, THE PATIENT REPORTED TREATMENT FROM A HEALTHCARE PROFESSIONAL IN THE ER.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
236688 OT ULTRA2 METER GLUCOSE MONITORING SYS/KIT NBW LIFESCAN EUROPE, A DIVISION OF CILAG GMBH INTL 3421595

Patients

Seq Age Sex Outcome Treatment
1 58 YR Hospitalization| L| R