BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ONE TOUCH ULTRA

    MDR report key: 581544 · Received March 2, 2005

    Report

    Report Number
    2939301-2005-00952
    Event Type
    Malfunction
    Date Received
    March 2, 2005
    Report Date
    February 25, 2005
    Manufacturer
    LIFESCAN, INC.
    Product Code
    CFR
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    A PATIENT REPORTED BLOOD GLUCOSE RESULTS OF "46, 201, 203 MG/DL, AND A READING OF HI" WITH A LIFESCAN METER, PERFORMED WITHIN 10 MINUTES OF EACH OTHER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ONE TOUCH ULTRA GLUCOSE MONITORING SYS/KIT CFR LIFESCAN, INC. NA 2516908

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN