FDA Adverse Event
Malfunction
Summary report: N
ACCU-CHEK ® AVIVA PLUS TEST STRIPS
MDR report key: 3202864
·
Received July 2, 2013
Report
- Report Number
- 1823260-2013-03991
- Event Type
- Malfunction
- Date Received
- July 2, 2013
- Date of Event
- June 3, 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
- TN, 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, ALL MG/DL: 285 AT 8:22 AM, 300 AT 8:30 AM, 120, OR 110 AT 8:40 AM. 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 |
|---|---|---|---|---|---|---|---|
| 302585 | ACCU-CHEK ® AVIVA PLUS TEST STRIPS | BLOOD GLUCOSE MONITORING TEST STRIPS | LFR | ROCHE DIAGNOSTICS | NA | 491369 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 53 YR | Male | ABILIFY| ADVAIR| HYDROCHLOROTHIAZIDE| HYDROXYZINE| METFORMIN| PRODERTIS(INHALER) ASTHMA| SIMVASTATIN| VALSARTAN| VALSARTAN| HYDROCHLOROTHIAZIDE| SIMVASTATIN| PRODERTIS (INHALER) ASTHMA| ADVAIR| HYDROXYZINE| METFORMIN| ABILIFY |