FDA Adverse Event Injury Summary report: N

MEDTRONIC MINIMED

MDR report key: 1669397 · Received April 24, 2010

Report

Report Number
MW5015694
Event Type
Injury
Date Received
April 24, 2010
Date of Event
April 23, 2010
Report Date
April 24, 2010
Manufacturer
MEDTRONIC MINIMED
Product Code
KZH
Adverse Event
Yes
Product Problem
Yes
Report Source
Voluntary report
Reporter Location
CA, US
Reporter Occupation
PATIENT

Narratives

Description of Event or Problem · 1

DUE TO A DESIGN FLAW IN THE MEDTRONIC MINIMED QUICK-SERTER MODEL MMT-395, DURING INSERTION OF A QUICK-SET MODEL MMT-393 INSULIN INFUSION SET, THE ADHESIVE PAD AROUND THE CANNULA ADHERED TO THE INSIDE OF THE QUICK-SERTER. IN THE PROCESS OF UN-STICKING THE ADHESIVE PAD FROM THE QUICK-SERTER, (B) (6) DAMAGED THE CANNULA. THIS RESULTED IN SEVERAL PROPERLY-REPORTED "NO DELIVERY" MESSAGES FROM (B) (6) MMT-522 INSULIN INFUSION PUMP OVER THE COURSE OF THE NEXT HOUR, ALONG WITH SEVERAL ATTEMPTS TO RE-START THE FLOW OF INSULIN TO THE PATIENT. AFTER APPROXIMATELY 2 HOURS, (B) (6) REMOVED THE DAMAGED INFUSION SET AND REPLACED IT. THE RESULTING LACK OF INSULIN DELIVERY, AS WELL AS THE UNCERTAINTY AS TO HOW MUCH INSULIN HAD BEEN DELIVERED - DURING THE BLOCKAGE DUE TO THE DESIGN FLAW IN THE QUICK-SERTER, A GREAT DEAL OF INSULIN SPILLED OUT OF THE INFUSION SET, BUT WAS THEREFORE TREATED AS HAVING BEEN DELIVERED BY THE PUMP-, RESULTED IN A SEVERE HYPERGLYCEMIC EPISODE FOR (B) (6), ALONG WITH TWO HYPOGLYCEMIC EVENTS LATER IN THE DAY RESULTING FROM OVER-CORRECTION OF THE HYPERGLYCEMIA. THE DESIGN FLAW IS THAT THE INTERIOR DIMENSION OF THE MMT-395 IS 41 MM, BUT THE ADHESIVE PAD IS 40 MM WIDE. THE LACK OF CLEARANCE BETWEEN THE EDGE OF THE PAD AND THE INSIDE OF THE PLUNGER-TUBE MAKES IT A COMMON FAILURE TO HAVE THE ADHESIVE PAD GET STUCK ONTO THE INSIDE OF THE PLUNGER-TUBE. THE CLEARANCES AND TOLERANCES INVOLVED MAKE IT OBVIOUS THAT THE MMT-395 IS SIMPLY NOT LARGE ENOUGH TO SAFELY INSERT QUICK-SET INFUSION SETS. DATES OF USE: (B) (6) 2004 - (B) (6) 2010. DIAGNOSIS OR REASON FOR USE: TYPE 1 DIABETES.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 MEDTRONIC MINIMED QUICK-SERTER KZH MEDTRONIC MINIMED MMT-395 MFG. IN 2008

Patients

Seq Age Sex Outcome Treatment
1 44 YR Life Threatening| S