FDA Adverse Event Injury Summary report: N

OT ULTRA METER

MDR report key: 3171408 · Received June 15, 2013

Report

Report Number
3008382007-2013-17311
Event Type
Injury
Date Received
June 15, 2013
Report Date
May 28, 2013
Manufacturer
LIFESCAN EUROPE, A DIVISION OF CILAG GMBH INTL
Product Code
NBW
PMA / PMN Number
K062195
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
MN, US
Reporter Occupation
PATIENT

Narratives

Description of Event or Problem · 1

ON (B)(6) 2013, THE LAY USER/PATIENT CONTACTED LIFESCAN (LFS) ALLEGING HER ONETOUCH ULTRA METER WAS DISPLAYING INACCURATE RESULTS WHEN COMPARED TO THE SAME METER. THE COMPLAINT WAS CLASSIFIED BASED ON THE CUSTOMER CARE ADVOCATE (CCA) DOCUMENTATION. THE PATIENT REPORTED ON (B)(6) 2013, AT 6AM, SHE OBTAINED READINGS OF ¿249 AND 241MG/DL¿ ON THE LFS METER. BASED ON STATISTICAL METHODOLOGY THE CALCULATED DIFFERENCE OF THE RESULTS EXCEEDS THE EXPECTED VALUE OF <=20% OR <=20MG/DL WHEN OBTAINED WITHIN 20 MINUTES. THE PATIENT REPORTED USING ORAL MEDICATIONS WITH DIET AND EXERCISE TO MANAGE HER DIABETES. THE PATIENT REPORTED TAKING HER USUAL METFORMIN 1000MG TWICE A DAY AND GLIPIZIDE 2.5MG ONCE A DAY ON (B)(6) 2013, AT 6AM. THE PATIENT REPORTED IMMEDIATELY AFTER THE ALLEGED ISSUE OCCURRED, SHE DEVELOPED SYMPTOMS OF ¿WARM AND SHAKY.¿ THE PATIENT DENIED RECEIVING ANY MEDICAL INTERVENTION IN RESPONSE TO HER SYMPTOMS. AT THE TIME OF TROUBLESHOOTING, THE CCA CONFIRMED THE METER WAS IN THE CORRECT UNIT OF MEASUREMENT DURING THE TIME OF TESTING AND THE PATIENT WAS USING AN APPROVED SAMPLE SITE TO OBTAIN THE SAMPLES. REPLACEMENT PRODUCTS WERE SENT TO THE PATIENT. THIS COMPLAINT IS BEING REPORTED AS AN ADVERSE EVENT BECAUSE THE PATIENT CLAIMED DUE TO THE ALLEGED ISSUE SHE TOOK HER USUAL DOSE OF MEDICATION AND SHE DEVELOPED SYMPTOMS SUGGESTIVE OF HYPOGLYCEMIA.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
272617 OT ULTRA METER GLUCOSE MONITORING SYS/KIT NBW LIFESCAN EUROPE, A DIVISION OF CILAG GMBH INTL 3442545

Patients

Seq Age Sex Outcome Treatment
1 76 YR