BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OMNIPOD INSULIN PUMP

    MDR report key: 1081591 · Received July 25, 2008

    Report

    Report Number
    3004464228-2008-00144
    Event Type
    Injury
    Date Received
    July 25, 2008
    Date of Event
    June 21, 2008
    Report Date
    June 26, 2008
    Manufacturer
    INSULET CORPORATION
    Product Code
    LZG
    PMA / PMN Number
    K042792
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THE PRODUCT HAS NOT BEEN RETURNED SO NO EVALUATION WAS POSSIBLE. THE CUSTOMER FELT RESISTANCE DURING THE FILL PROCESS, WHICH INDICATES A PROBABLE PROBLEM WITH A RETAINER THAT ALLOWED A COMPONENT TO MOVE RESULTING IN DAMAGE WHICH PREVENTED THE PLUNGER FROM ADVANCING. THE USER WOULD HAVE BEEN AWARE OF A PROBLEM DURING THE FILL PROCESS. THERE IS RESISTANCE FELT IN FILLING THE POD WITH INSULIN AND A DISTINCT "CRACKLING" NOISE RESULTING FROM STRIPPING THE THREADS OF THE COMPONENT WHEN OVER-PRESSURISED. THE OMNIPOD USER GUIDE STATES: "WARNING: NEVER USE A POD IF, DURING FILL, YOU DETECT ANY CRACKLING NOISE OR RESISTANCE WHILE DEPRESSING THE PLUNGER OF THE FILL SYRINGE. USING A POD WITH THESE CONDITIONS COULD RESULT IN UNDER-DELIVERY OF INSULIN." THE USER IS ALSO INSTRUCTED IN THE USER GUIDE TO FREQUENTLY MONITOR THEIR BG LEVELS. BY FOLLOWING THESE RECOMMENDATIONS, THE USER WOULD BECOME AWARE OF HIGH BG LEVELS AND COULD USE ANOTHER DEVICE OR BACKUP THERAPY IF REQUIRED.

    Description of Event or Problem · 1

    CUSTOMER CALLED IN REGARDING POD THAT MADE A CLICKING SOUND AND WAS DIFFICULT TO FILL. SHE WAS ADVISED NOT TO USE A POD THAT IS DIFFICULT TO FILL. CUSTOMER STATED THAT SHE WENT TO BED AT MIDNIGHT. AT 5:00 AM, HER BG READ HIGH, SO SHE BOLUSED 6 UNITS WITH THE POD. AT 6:00 AM, SHE BOLUSED 18 UNITS THROUGH SYRINGE. AT 7:30 AM, SHE TOOK THE POD OFF AND WENT TO THE HOSPITAL WHERE SHE WAS PUT ON AN IV UNTIL MONDAY 23RD. NO FURTHER INFORMATION REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 OMNIPOD INSULIN PUMP PUMP, INFUSION, INSULIN LZG INSULET CORPORATION 11200 L11689

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization