MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a consumer report with the FDA on 2020-01-03 for CONTOUR manufactured by Ascensia Diabetes Care Us Inc..
[173926840]
The customer stated that the medical provider was using her own medical supplies, therefore, no product information could be obtained related to the control solution and the product is not expected to be returned. The patient/family was the initial reporter, so personal information was not entered. Weight was left blank as the customer's weight was not provided. Since no product details were provided, model #, lot # and expiration date were not captured, and device manufacture date could not be determined.
Patient Sequence No: 1, Text Type: N, H10
[173926841]
The customer visited her medical provider for the normal appointment. The medical provider performed a control test using the customer's contour meter and obtained a reading of 372 mg/dl. The meter did not automatically mark it as a control test, and so the reading will be displayed as a blood result when accessing the meter's memory. There was no allegation of an adverse event. The control solution is not expected to be returned for evaluation. A replacement meter kit was sent to the customer.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1810909-2020-00007 |
| MDR Report Key | 9543952 |
| Report Source | CONSUMER |
| Date Received | 2020-01-03 |
| Date of Report | 2019-12-04 |
| Date of Event | 2019-12-04 |
| Date Mfgr Received | 2020-03-06 |
| Date Added to Maude | 2020-01-03 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 0 |
| Initial Report to FDA | 0 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | SHWETA GULATI |
| Manufacturer Street | 100 SUMMIT LAKE DRIVE |
| Manufacturer City | VALHALLA, NY NY 10595 |
| Manufacturer Country | US |
| Manufacturer Postal | 10595 |
| Manufacturer Phone | 9142361830 |
| Manufacturer G1 | BIONOSTICS, INC. BUSINESS TRADE NAME: RNA MEDICAL |
| Manufacturer Street | REGISTRATION NUMBER: 1220649 7 JACKSON RD. |
| Manufacturer City | DEVENS MA 01434 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 01434 |
| Single Use | 3 |
| Remedial Action | RL |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | CONTOUR |
| Generic Name | QUALITY CONTROL MATERIAL |
| Product Code | JJX |
| Date Received | 2020-01-03 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ASCENSIA DIABETES CARE US INC. |
| Manufacturer Address | 100 SUMMIT LAKE DRIVE VALHALLA NY 10595 US 10595 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-01-03 |