BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ONE TOUCH BASIC ORIGINAL

    MDR report key: 421462 · Received April 15, 2002

    Report

    Report Number
    2939301-2002-05200
    Event Type
    Malfunction
    Date Received
    April 15, 2002
    Report Date
    April 4, 2002
    Manufacturer
    LIFESCAN, INC.
    Product Code
    CFR
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AZ, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    A PT REPORTED EXPERIENCING INACCURATE ERRATIC RESULTS WITH A OT BASIC ORIGINAL METER. THE PT'S BLOOD GLUCOSE RESULTS WERE 94, 180, 275 MG/DL. TESTS WERE DONE WITHIN 10 MINS WITH A DIFFERENCE OF 58%. PT DID NOT EXPERIENCE ANY ADVERSE EVENTS. NO FURTHER INFO HAS BEEN REPORTED. NOTE-CUSTOMER WAS CLEANING THE METER INCORRECTLY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ONE TOUCH BASIC ORIGINAL BLOOD GLUCOSE MONITORING KIT/SYSTEM CFR LIFESCAN, INC. NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR