FDA Adverse Event Injury Summary report: N

ACCU-CHEK SPIRIT

MDR report key: 1984428 · Received January 31, 2011

Report

Report Number
2183996-2011-00096
Event Type
Injury
Date Received
January 31, 2011
Date of Event
January 9, 2011
Report Date
January 11, 2011
Manufacturer
ROCHE INSULIN DELIVERY SYSTEMS INC.
Product Code
LZG
PMA / PMN Number
K060876
Removal / Correction Number
NA
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Occupation
UNKNOWN

Narratives

Additional Manufacturer Narrative · 1

NO PRODUCT WILL BE RETURNED FOR EVALUATION.

Description of Event or Problem · 1

ON (B)(6) 2011, PT REPORTED SHE NEEDS TO LOWER THE BASAL RATE ON HER INFUSION DEVICE BECAUSE SHE HAD A SEVERE LOW BLOOD GLUCOSE LEVEL REQUIRING HOSPITALIZATION. PT STATED ON (B)(6) 2011, SHE WAS SLEEPING AND HER HUSBAND HEARD HER WHIMPERING. PT REPORTED HER HUSBAND WOKE UP AND FOUND HER UNRESPONSIVE AND THEN SHE WENT INTO A SEIZURE. PT STATED HER BLOOD GLUCOSE LEVEL WAS UNK BECAUSE SHE WAS UNCONSCIOUS. PATIENT'S NORMAL BLOOD GLUCOSE RANGE IS 4-9 MMOL/L (72-162 MG/DL). PT STATED HER HUSBAND CALLED THE PARAMEDICS IMMEDIATELY. PT REPORTED SHE WAS GIVEN A GLUCOSE INJECTION BY THE PARAMEDICS AND TRANSPORTED TO THE HOSPITAL. PT STATED SHE WAS AT THE HOSPITAL FOR ABOUT 8 HOURS AND THEY RAN VARIOUS TESTS AND TOOK X-RAYS. PT REPORTED THE HOSPITAL DETERMINED THE SEIZURE WAS DUE TO EXTREMELY LOW BLOOD GLUCOSE AND SHE WAS RELEASED THE SAME DAY. PT STATED SHE HAS BEEN HAVING FREQUENT LOW BLOOD GLUCOSE BUT HAS BEEN ABLE TO SELF TREAT WITH JUICE EACH TIME. PT REPORTED SHE IS GOING TO KEEP WORKING WITH HER DOCTOR TO SEE HOW THIS CONCERN CAN BEST BE ADDRESSED. TROUBLESHOOTING DID NOT FIND ANY PRODUCT ISSUES. NO PRODUCT RETURN WAS REQUESTED.

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 31 YR Hospitalization| O| R INSULIN INFUSION SET| INSULIN