MAUDE Adverse Event Report: LIFESCAN EUROPE GMBH OT VERIO REFLECT METER; GLUCOSE MONITORING SYS/KIT

Model Number	023-927
Medical Device Problem Code	Incorrect, Inadequate or Imprecise Result or Readings (1535)
Health Effect - Clinical Code	Hypoglycemia (1912)
Type of Reportable Event	Serious Injury
Event or Problem Description
On (b)(6) 2022, a reporter for the lay-user/patient contacted lifescan (lfs) italy, alleging that the patient¿s onetouch verio reflect meter displayed inaccurate readings.The complaint was classified based on the customer care agent (cca) documentation, since the patient could not be contacted for further information.It was not reported when the alleged meter inaccuracy began.The reporter was unable to provide the alleged inaccurate results obtained with the subject meter.It is not known how the patient manages their diabetes or if they made any changes to their usual diabetes management regimen as a result of the alleged issue.The reporter claimed the patient experienced ¿hypoglycemia¿ after the alleged issue began and received unspecified treatment by emergency medical services.The reporter was unable to provide further information.Troubleshooting was unable to be performed.This complaint is being reported because the patient reportedly received medical intervention for an acute low blood glucose excursion after the alleged issue began.There is insufficient information to rule out the contribution of the subject meter to the event.

• Brand Name: OT VERIO REFLECT METER
• Common Device Name: GLUCOSE MONITORING SYS/KIT
• Manufacturer (Section D): LIFESCAN EUROPE GMBH; gubelstrasse 34; zug 6300 ; SZ 6300
• MDR Report Key: 15643320
• Report Number: 2939301-2022-03115
• Device Sequence Number: 17698348
• Product Code: NBW
• UDI-Device Identifier: 00353885011693
• UDI-Public: 00353885011693
• Combination Product (Y/N): N
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Importer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 10/20/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Lay User/Patient
• Device Model Number: 023-927
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: Yes
• Distributor Facility Aware Date: 10/14/2022
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 10/20/2022
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: A
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention; Life Threatening
• Patient Sex: Unknown