BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® AVIVA PLUS TEST STRIPS

    MDR report key: 4170957 · Received October 14, 2014

    Report

    Report Number
    1823260-2014-07872
    Event Type
    Malfunction
    Date Received
    October 14, 2014
    Date of Event
    September 16, 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
    WA, 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 OF "LOWER THAN 135" MG/DL AND "IN THE 200S" MG/DL WITHIN 10 MINUTES. 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
    649317 ACCU-CHEK ® AVIVA PLUS TEST STRIPS BLOOD GLUCOSE MONITORING TEST STRIPS LFR ROCHE DIAGNOSTICS NA 493745

    Patients

    Seq Age Sex Outcome Treatment
    1 67 YR Female ASPIRIN| CALCIUM| CPAP| FUROSEMIDE| LEVOTHYROXINE| LISINOPRIL| METFORMIN| OMEPRAZOLE| RESPIRONICS BREATHING MACHINE| SPIRONOLACTONE| VITAMIN B12| VITAMIN D| CALCIUM| VITAMIN B12| SPIRONOLACTONE| OMEPRAZOLE| CPAP| VITAMIN D| ASPIRIN| FUROSEMIDE| LISINOPRIL| LEVOTHYROXINE| RESPIRONICS BREATHING MACHINE| METFORMIN