FDA Adverse Event Malfunction Summary report: N

OMNIPOD DASH¿ INSULIN MANAGEMENT SYSTEM

MDR report key: 15821822 · Received November 17, 2022

Report

Report Number
3004464228-2022-21498
Event Type
Malfunction
Date Received
November 17, 2022
Date of Event
November 4, 2022
Report Date
November 10, 2022
Manufacturer
INSULET CORPORATION
Product Code
LZG
UDI-DI
10385082000139
PMA / PMN Number
K192659
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MA, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 0

A TECHNICAL ASSESSMENT OF THE DEVICE DESIGN IDENTIFIED THE ROOT CAUSE OF THE THERMAL EVENT TO BE THE DASH PDM CHARGING VOLTAGE EXCEEDING THE BATTERY SPECIFICATION, DEFINED AS OVERCHARGING. FIELD SAFETY CORRECTIVE ACTION HAS BEEN INITIATED BY INSULET CORPORATION. THE DEVICE WILL NOT BE RETURNED FOR INVESTIGATION.

Additional Manufacturer Narrative · 0

A TECHNICAL ASSESSMENT OF THE DEVICE DESIGN IDENTIFIED THE ROOT CAUSE OF THE THERMAL EVENT TO BE THE DASH PDM CHARGING VOLTAGE EXCEEDING THE BATTERY SPECIFICATION, DEFINED AS OVERCHARGING. FIELD SAFETY CORRECTIVE ACTION HAS BEEN INITIATED BY INSULET CORPORATION. THE DEVICE WILL NOT BE RETURNED FOR INVESTIGATION.

Description of Event or Problem · 0

IT WAS REPORTED BY THE PATIENT THAT THE OMNIPOD PERSONAL DIABETES MANAGER (PDM) IS NOT HOLDING CHARGE. THE PDM WOULD HOLD CHARGE FOR 2-3 HOURS THEN IMMEDIATE DROP TO ALMOST 0%.

Description of Event or Problem · 0

IT WAS REPORTED BY THE PATIENT THAT THE OMNIPOD PERSONAL DIABETES MANAGER (PDM) IS NOT HOLDING CHARGE. THE PDM WOULD HOLD CHARGE FOR 2-3 HOURS THEN IMMEDIATE DROP TO ALMOST 0%.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
238516 OMNIPOD DASH¿ INSULIN MANAGEMENT SYSTEM PUMP, INFUSION, INSULIN LZG INSULET CORPORATION PT-000010 L000335 10385082000139

Patients

Seq Age Sex Outcome Treatment
1 Male