BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® PERFORMA TEST STRIPS

    MDR report key: 3981568 · Received August 5, 2014

    Report

    Report Number
    1823260-2014-05901
    Event Type
    Malfunction
    Date Received
    August 5, 2014
    Date of Event
    June 28, 2014
    Report Date
    July 28, 2025
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    LFR
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AS
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE
    Health Professional
    N

    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.

    Description of Event or Problem · 1

    REPORTER STATED THAT CUSTOMER RECEIVED THE FOLLOWING RESULTS ON THE PERFORMA SYSTEM WITHIN 8 MINUTES: 25.1 MMOL/L, 3.3 MMOL/L, 3.7 MMOL/L AND 3.9 MMOL/L. CUSTOMER FELT HUNGRY AND SHAKY AT THE TIME OF THE 25.1 MMOL/L RESULT. AFTER THE RESULT OF 3.3 MMOL/L CUSTOMER SELF-TREATED WITH 2 CHOCOLATE BISCUITS AND A SLICE OF BREAD WITH HONEY. NO ADVERSE EVENT REPORTED. THE MANUFACTURER REQUESTED RETURN OF SUSPECT PRODUCT FOR EVALUATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    457150 ACCU-CHEK ® PERFORMA TEST STRIPS BLOOD GLUCOSE MONITORING TEST STRIPS LFR ROCHE DIAGNOSTICS NA 471832

    Patients

    Seq Age Sex Outcome Treatment
    1 38 YR Female NOVORAPID| NOVORAPID