MAUDE Adverse Event Report: ASCENSIA DIABETES CARE US INC. CONTOUR NEXT EZ; BLOOD GLUCOSE METER

Model Number	7252
Medical Device Problem Code	Missing Test Results (3267)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	09/17/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The patient/family was the initial reporter, so personal information was not entered.No information was captured as the customer's weight was not provided.
Event or Problem Description
The customer reported that his blood glucose reading were not being stored in the memory of the contour next ez meter.There was no allegation of an adverse event.The customer was advised to return the device for evaluation.A replacement meter kit was sent to the customer.
Additional Manufacturer Narrative
The customer did not return the device for evaluation.Therefore, a device history record was reviewed for the suspected contour next ez meter and no manufacturing anomalies were found.
Additional Manufacturer Narrative
The customer returned the suspected contour next ez meter for evaluation.During the investigation, the meter switched on as expected.The customer service mode was run and no anomalies were found.Three control tests were run using the returned meter with the in-house contour next control solution and in-house contour next test strips, which gave a satisfactory performance.The returned meter was also tested with the in-house contour next test strips and in-house breeze2 control solution to simulate as blood, which gave a satisfactory performance.The simulated blood glucose reading obtained during in-house testing was properly stored in the meter's memory.

• Brand Name: CONTOUR NEXT EZ
• Common Device Name: BLOOD GLUCOSE METER
• Manufacturer (Section D): ASCENSIA DIABETES CARE US INC.; 100 summit lake drive; valhalla NY 10595
• MDR Report Key: 10670428
• Report Number: 1810909-2020-00539
• Device Sequence Number: 14135119
• Product Code: NBW
• UDI-Device Identifier: 00301937252013
• UDI-Public: 00301937252013
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K111268
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: consumer
• Initial Reporter Occupation: Other
• Remedial Action: Replace
• Type of Report: Initial,Followup,Followup,Followup
• Report Date (Section B): 09/17/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Lay User/Patient
• Device Model Number: 7252
• Device Catalogue Number: 7252
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/25/2021
• Initial Date Received by Manufacturer: 09/17/2020
• Supplement Date Received by Manufacturer: 12/08/2020; 12/08/2020; 03/25/2021
• Initial Report FDA Received Date: 10/13/2020
• Supplement Report FDA Received Date: 12/09/2020; 12/10/2020; 03/29/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 71 YR