FDA Adverse Event Malfunction Summary report: N

ACCU-CHEK SPIRIT

MDR report key: 1212692 · Received October 22, 2008

Report

Report Number
2183996-2008-01610
Event Type
Malfunction
Date Received
October 22, 2008
Date of Event
October 1, 2008
Report Date
October 1, 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
AZ, US
Reporter Occupation
UNKNOWN

Narratives

Additional Manufacturer Narrative · 1

NO PRODUCT WILL BE RETURNED FOR EVAL.

Description of Event or Problem · 1

ON (B) (6) 2008, THE PT REPORTED HE KEEPS RECEIVING OCCLUSION MESSAGES ON HIS INSULIN INFUSION DEVICE. HE STATED HE HAS CHANGED HIS INFUSION SET, CARTRIDGE, AND BATTERY BUT THE OCCLUSION MESSAGES CONTINUE. TO TROUBLESHOOT, THE PT WAS INSTRUCTED TO TAKE OFF ALL ACCESSORIES AND PERFORM A DRY PRIME WHICH HE DID WITHOUT ERROR. THE PT WAS THEN INSTRUCTED TO REINSERT HIS INSULIN CARTRIDGE INTO THE DEVICE. THE PT DID SO AND THE DEVICE IMMEDIATELY GAVE AN OCCLUSION MESSAGE. THE PT STATED THE PISTON ROD DOES NOT APPEAR TO BE DIRTY BUT DURING HIS LAST CARTRIDGE CHANGE, HE DID NOTICE MOISTURE IN THE CARTRIDGE CHAMBER OF HIS DEVICE. THE PT WAS ADVISED TO SWITCH TO HIS BACKUP INFUSION DEVICE AND TO USE THE SAME ACCESSORIES. ON FOLLOW UP WITH THE PT, HE STATED HE SWITCHED BACK TO HIS PRIMARY DEVICE AND HAS HAD NO FURTHER OCCLUSION ALARMS. THE PT DID NOT REPORT BLOOD GLUCOSE CONCERNS RELATED TO THIS ISSUE. THE PT DID NOT REQUIRE ASSISTANCE FROM A HEALTHCARE PROFESSIONAL OR SECOND PARTY TO ADDRESS THE ISSUE. NO PRODUCT WILL BE RETURNED FOR EVAL.

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 44 YR INSULIN| INSULIN INFUSION SET