BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® MOBILE TEST STRIPS

    MDR report key: 3173363 · Received June 17, 2013

    Report

    Report Number
    1823260-2013-03627
    Event Type
    Malfunction
    Date Received
    June 17, 2013
    Date of Event
    April 28, 2013
    Report Date
    July 16, 2013
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    THE EVENT OCCURRED IN (B)(6). WHILE THIS PRODUCT IS NOT SOLD IN THE UNITED STATES, IT IS LIKE OR SIMILAR TO A PRODUCT MARKETED IN THE UNITED STATES. THIS MEDWATCH IS FOR MOBILE SYSTEM 2. REFERENCE MEDWATCH WITH PATIENT IDENTIFIER (B)(6) FOR THE MOBILE SYSTEM 1.

    Description of Event or Problem · 1

    REPORTER STATED THAT CUSTOMER RECEIVED THE FOLLOWING RESULTS ON 2 DIFFERENT METERS WITHIN 2 MINUTES: 487 MG/DL (MOBILE SYSTEM 1) AND 135 MG/DL (MOBILE SYSTEM 2) - STRIP LOT IS UNKNOWN; 343 MG/DL (MOBILE SYSTEM 1) AND 134 MG/DL (MOBILE SYSTEM 2) - STRIP LOT 278186 SETS OF READINGS WERE TAKEN ON DIFFERENT DAYS. NO ACTIONS TAKEN BASED ON DEVICE RESULTS. NO ADVERSE EVENT DUE TO THE DEVICE REPORTED. THE MANUFACTURER REQUESTED RETURN OF SUSPECT PRODUCT FOR EVALUATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    273839 ACCU-CHEK ® MOBILE TEST STRIPS BLOOD GLUCOSE MONITORING TEST STRIPS LFR ROCHE DIAGNOSTICS NA 278186

    Patients

    Seq Age Sex Outcome Treatment
    1 074 YR