BEUDAMED
    FDA Adverse Event Other Summary report: N

    ONE TOUCH ULTRA

    MDR report key: 904006 · Received August 26, 2004

    Report

    Report Number
    2939301-2004-04666
    Event Type
    Other
    Date Received
    August 26, 2004
    Report Date
    August 25, 2004
    Manufacturer
    LIFESCAN, INC.
    Product Code
    NBW
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    PATIENT

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ONE TOUCH ULTRA GLUCOSE MONITORING SYS/KIT NBW LIFESCAN, INC. NA 2519902

    Patients

    Seq Age Sex Outcome Treatment
    1 YR