BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK SPIRIT

    MDR report key: 1163424 · Received September 10, 2008

    Report

    Report Number
    2183996-2008-01370
    Event Type
    Malfunction
    Date Received
    September 10, 2008
    Date of Event
    August 30, 2008
    Report Date
    August 30, 2008
    Manufacturer
    DISETRONIC MEDICAL SYSTEMS
    Product Code
    LZG
    PMA / PMN Number
    K060876
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SC, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    ON (B)(6) 2008, THE PATIENT'S HUSBAND REPORTED THAT WHILE CHANGING THE PATIENT'S INSULIN CARTRIDGE, THE PLUNGER BECAME STUCK TO THE PISTON ROD AND A FULL CARTRIDGE OF INSULIN SPILLED INTO THE CARTRIDGE COMPARTMENT OF THE INFUSION DEVICE. THE CALLER WAS EDUCATED ON THE PROPER PROCEDURE FOR CHANGING THE INSULIN CARTRIDGE. HE WAS ASSISTED IN SETTING UP THE PATIENT'S BACKUP INFUSION DEVICE. NO PHYSIOLOGICAL EFFECTS WERE REPORTED. THE PATIENT DID NOT REQUIRE MEDICAL ASSISTANCE FROM A HEALTHCARE PROFESSIONAL OR SECOND PARTY TO ADDRESS THE ISSUE. PRODUCT WAS REPLACED AND REQUESTED TO BE RETURNED FOR EVALUATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACCU-CHEK SPIRIT INSULIN INFUSION PUMP LZG DISETRONIC MEDICAL SYSTEMS NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR INSULIN| INSULIN INFUSION SET