FDA Adverse Event Injury Summary report: N

OT ULTRASMART METER

MDR report key: 3191947 · Received June 27, 2013

Report

Report Number
3008382007-2013-18565
Event Type
Injury
Date Received
June 27, 2013
Report Date
June 18, 2013
Manufacturer
LIFESCAN EUROPE, A DIVISION OF CILAG GMBH INTL
Product Code
NBW
PMA / PMN Number
K021819
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CA
Reporter Occupation
PATIENT

Narratives

Description of Event or Problem · 1

ON (B)(6) 2013, A LAY USER/ PATIENT CONTACTED LIFESCAN (LFS) IN (B)(4) ALLEGING HIS ONETOUCH ULTRASMART METER HAD A DISPLAY ISSUE ¿SOMETIMES IT WORKED AND SOMETIMES IT DIDN¿T¿. HE REPORTEDLY HAD TO TEST 10 TIMES BEFORE GETTING A READING. THIS COMPLIANT WAS DOCUMENTED USING THE CUSTOMER CARE ADVOCATE (CCA) DOCUMENTATION. THE PATIENT REPORTED 1 WEEKS PRIOR TO CONTACTING LFS THE ALLEGED ISSUE FIRST OCCURRED. THE PATIENT REPORTED USING A COMBINATION OF MEDICATIONS INCLUDING METFORMIN, 32 UNITS OF LANTUS INSULIN TWICE A DAY AND HUMALOG INSULIN. THE PATIENT REPORTED A COUPLE OF WEEKS PRIOR TO CONTACTING LFS THE PATIENT HAD BEEN INCREASING HIS USUAL DOSE OF HUMALOG TO 26 UNITS 4 TIMES A DAY. THE PATIENT REPORTED SOMETIME AFTER THE ALLEGED ISSUE OCCURRED HE DEVELOPED SYMPTOMS OF ¿BLURRED VISION AND TIRED¿ WHICH HE ASSOCIATED WITH HYPOGLYCEMIA. THE PATIENT REPORTED DURING THE WEEK PRIOR TO CONTACTING LFS, A READING OF ¿44.0MMOL/L¿ WAS OBTAINED ON A HOSPITAL METER AND HE WAS TREATED IN THE HOSPITAL WITH IV FLUIDS AND INSULIN DRIP AND STAYED 1 WEEK. AT THE TIME OF TROUBLESHOOTING, THE CCA WAS UNABLE TO RESOLVE THE ALLEGED ISSUE AND CONFIRMED IT WAS NOT THE FIRST TIME THE METER HAD BEEN USED. THIS COMPLAINT IS BEING REPORTED AS AN ADVERSE EVENT BECAUSE, THE PATIENT CLAIMS DUE TO THE ALLEGED ISSUE, HE GAVE HIMSELF TOO MUCH MEDICATION, SUFFERED SYMPTOMS SUGGESTIVE OF HYPOGLYCEMIA AND REQUIRED TREATMENT FROM A HEALTHCARE PROFESSIONAL.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
294288 OT ULTRASMART METER GLUCOSE MONITORING SYS/KIT NBW LIFESCAN EUROPE, A DIVISION OF CILAG GMBH INTL

Patients

Seq Age Sex Outcome Treatment
1