BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COAGUCHEK® XS SYSTEM

    MDR report key: 4040701 · Received August 27, 2014

    Report

    Report Number
    1823260-2014-06532
    Event Type
    Malfunction
    Date Received
    August 27, 2014
    Date of Event
    July 30, 2014
    Report Date
    September 18, 2014
    Manufacturer
    ROCHE DIAGNOSTICS
    Product Code
    GJS
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    UK
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    THE EVENT OCCURRED IN (B)(6).

    Description of Event or Problem · 1

    CALLER STATES THE PATIENT TESTED 2.5 INR ON THE COAGUCHEK XS PRO SYSTEM WHILE A COMPARISON LAB RETURNED AS 1.1 INR. NO ACTIONS TAKEN BASED ON THE DEVICE RESULT. NO ADVERSE EVENT REPORTED. REQUESTED RETURN OF SUSPECT SYSTEM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    519238 COAGUCHEK® XS SYSTEM PROTHROMBIN TIME TEST STRIPS GJS ROCHE DIAGNOSTICS NA ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1 085 YR FUROSEMIDE DAILY| LAXIDO TWICE DAILY| BISOPROLOL DAILY| MEMANTINE DAILY| EZETIMIBE| WARFARIN| QUININE DAILY| OXYTETRACYCLINE TWICE DAILY