BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® AVIVA PLUS TEST STRIPS

    MDR report key: 3994399 · Received August 8, 2014

    Report

    Report Number
    1823260-2014-06042
    Event Type
    Malfunction
    Date Received
    August 8, 2014
    Date of Event
    July 22, 2014
    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
    NY, 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

    CUSTOMER REPORTEDLY RECEIVED THE FOLLOWING RESULTS ON THE AVIVA PLUS SYSTEM WITHIN 10 MINUTES: 354 MG/DL, 138 MG/DL, AND 130 MG/DL. NO ACTIONS TAKEN BASED ON DEVICE RESULTS. NO ADVERSE EVENT REPORTED. REQUESTED RETURN OF SUSPECT DEVICE AND REPLACEMENT WAS SENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    469821 ACCU-CHEK ® AVIVA PLUS TEST STRIPS BLOOD GLUCOSE MONITORING TEST STRIPS LFR ROCHE DIAGNOSTICS NA 492171

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR Male LANTUS| LOSARTAN| METFORMIN| NOVOLOG| SIMVASTATIN| TAMSULOSIN| LOSARTAN| METFORMIN| NOVOLOG| TAMSULOSIN| SIMVASTATIN| LANTUS