BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK SPIRIT

    MDR report key: 1830503 · Received September 2, 2010

    Report

    Report Number
    2183996-2010-01814
    Event Type
    Malfunction
    Date Received
    September 2, 2010
    Date of Event
    August 24, 2010
    Report Date
    August 25, 2010
    Manufacturer
    ROCHE INSULIN DELIVERY SYSTEMS, INC.
    Product Code
    LZG
    PMA / PMN Number
    K060876
    Removal / Correction Number
    Z-1415-2009
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    DE, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    ON (B)(6) 2010, PT REPORTED THE UP AND DOWN BUTTONS ON THE INFUSION DEVICE WERE DEFECTIVE. PT DOES NOT KNOW WHEN ISSUE BEGAN BUT NOTICED BUTTON FAILURE ON (B)(6) 2010 WHEN TRYING TO VIEW BOLUS HISTORY. PT SWITCHED TO BACKUP INFUSION DEVICE. PT BOLUSES AT LEAST THREE TIMES PER DAY; SHE DOES NOT KNOW HOW LONG SHE HAS USED THIS INFUSION DEVICE. BUTTONS POP UP AFTER BEING PRESSED. INFUSION DEVICE WAS NOT DROPPED OR EXPOSED TO WATER OR INSULIN INGRESS. INFUSION DEVICE WAS REPLACED AND REQUESTED FOR EVALUATION. NO PHYSIOLOGICAL EFFECTS WERE REPORTED. THE PT DID NOT REQUIRE TREATMENT FROM A HEALTH CARE PROFESSIONAL OR SECOND PARTY TO ADDRESS THE ISSUE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACCU-CHEK SPIRIT INSULIN INFUSION PUMP LZG ROCHE INSULIN DELIVERY SYSTEMS, INC. NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR INFUSION SET| INSULIN