BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    OT VERIO IQ METER

    MDR report key: 4252627 · Received November 15, 2014

    Report

    Report Number
    2939301-2014-30842
    Event Type
    Malfunction
    Date Received
    November 15, 2014
    Report Date
    November 7, 2014
    Manufacturer
    LIFESCAN EUROPE, A DIVISION OF CILAG GMBH INTL
    Product Code
    NBW
    PMA / PMN Number
    K110637
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FR
    Reporter Occupation
    PATIENT

    Narratives

    Additional Manufacturer Narrative · 1

    LIFESCAN (LFS) HAS REQUESTED RETURN OF THE SUBJECT PRODUCT(S) FOR EVALUATION. IF THE PRODUCT(S) ARE RETURNED, LFS WILL EVALUATE THEM AND INFORM FDA OF PRODUCT(S) THAT DO NOT PASS INSPECTION IN A SUPPLEMENTAL REPORT.

    Description of Event or Problem · 1

    ON (B)(6)2014, THE REPORTER CONTACTED LIFESCAN (B)(6) ALLEGING THAT THE SUBJECT METER (ONE TOUCH VERIO IQ) READ INACCURATELY ERRATIC. THE REPORTER WAS UNABLE TO GIVE EXACT VALUES. THE TESTS WERE PERFORMED WITHIN AN UNKNOWN TIME OF EACH OTHER. THIS COMPLAINT IS BEING REPORTED BECAUSE THE REPORTED ISSUE WAS NOT RESOLVED WITH TROUBLESHOOTING, SINCE WE COULD NOT CONFIRM THAT THE CALCULATED DIFFERENCE EXCEEDED OUR CRITERIA AS NO VALUES WERE GIVEN. THERE WAS NO INDICATION THAT THE PRODUCT CAUSED OR CONTRIBUTED TO AN ADVERSE EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    740644 OT VERIO IQ METER GLUCOSE MONITORING SYS/KIT NBW LIFESCAN EUROPE, A DIVISION OF CILAG GMBH INTL 3669944

    Patients

    Seq Age Sex Outcome Treatment
    1 31 YR