FDA Adverse Event Injury Summary report: N

OT ULTRA2 METER

MDR report key: 4220131 · Received November 3, 2014

Report

Report Number
2939301-2014-29413
Event Type
Injury
Date Received
November 3, 2014
Date of Event
October 26, 2014
Report Date
October 26, 2014
Manufacturer
LIFESCAN EUROPE, A DIVISION OF CILAG GMBH INTL
Product Code
NBW
PMA / PMN Number
K053529
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
NY, US
Reporter Occupation
PATIENT

Narratives

Description of Event or Problem · 1

ON (B)(6) 2014, THE LAY-USER/PATIENT CONTACTED LIFESCAN (LFS) USA, ALLEGING THAT HER ONETOUCH ULTRA2 METER WAS REVERTING TO SET UP MODE. THE COMPLAINT WAS CLASSIFIED BASED ON THE CUSTOMER SERVICE REPRESENTATIVE (CSR) DOCUMENTATION, SINCE THE PATIENT WAS UNABLE TO BE REACHED BY PHONE FOR ADDITIONAL INFORMATION. THE PATIENT REPORTED THAT THE ALLEGED METER ISSUE BEGAN ON (B)(6) 2014, AT 10:00AM. THE PATIENT MANAGES HER DIABETES WITH ORAL MEDICATION, DIET AND EXERCISE AND DENIED MAKING ANY CHANGES TO HER USUAL DIABETES MANAGEMENT REGIMEN IN RESPONSE TO THE ALLEGED ISSUE. THE PATIENT REPORTED DEVELOPING SYMPTOMS OF ¿BEING NERVOUS, BODY WAS TREMBLING¿, IMMEDIATELY AFTER THE ALLEGED METER ISSUE BEGAN. THE PATIENT DENIED RECEIVING ANY MEDICAL TREATMENT DUE TO THE ALLEGED METER ISSUE. AT THE TIME OF TROUBLESHOOTING, THE CSR NOTED THAT THE SUBJECT METER WAS BEING USED FOR THE FIRST TIME. THE CSR DOCUMENTED THERE WAS NO INDICATION OF MISUSE OF THE PRODUCT. THE CSR WALKED THROUGH RESOLVING THE ISSUE AND THE ALLEGED METER ISSUE WAS RESOLVED. THIS COMPLAINT IS BEING REPORTED BECAUSE THE PATIENT REPORTEDLY DEVELOPED SYMPTOMS SUGGESTIVE OF SEVERE HYPOGLYCEMIA AFTER THE ALLEGED PRODUCT ISSUE BEGAN.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
701044 OT ULTRA2 METER GLUCOSE MONITORING SYS/KIT NBW LIFESCAN EUROPE, A DIVISION OF CILAG GMBH INTL 3606047

Patients

Seq Age Sex Outcome Treatment
1 74 YR Life Threatening