BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK SPIRIT

    MDR report key: 2006189 · Received February 18, 2011

    Report

    Report Number
    2183996-2011-00269
    Event Type
    Malfunction
    Date Received
    February 18, 2011
    Date of Event
    January 19, 2011
    Report Date
    February 4, 2011
    Manufacturer
    ROCHE INSULIN DELIVERY SYSTEM INC.
    Product Code
    LZG
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    UNKNOWN

    Narratives

    Additional Manufacturer Narrative · 1

    THIS INCIDENT OCCURRED OUTSIDE THE UNITED STATES. INFO CONTAINED WITHIN THIS REPORT IS ALL THAT IS AVAILABLE AT THIS TIME. IF FURTHER INFO IS OBTAINED, IT WILL BE PROVIDED IN THE SUPPLEMENTAL REPORT.

    Description of Event or Problem · 1

    THE PT REPORTED EXPERIENCING ELEVATED BLOOD GLUCOSE RANGING FROM 152-286 MG/DL FROM (B)(6) 2011 - (B)(6) 2011 DESPITE BOLUSING THROUGH THE INFUSION DEVICE. HIS NORMAL BLOOD GLUCOSE RANGE IS 90-120 MG/DL. HE SWITCHED TO ANOTHER INFUSION DEVICE USING THE SAME BASAL RATES AND HIS BLOOD GLUCOSE DECREASED. NO FURTHER INFO IS AVAILABLE. THE PT DID NOT REQUIRE TREATMENT FROM A HEALTH CARE PROFESSIONAL OR SECOND PARTY TO ADDRESS THE ISSUE. THE INFUSION DEVICE WAS REPLACED AND REQUESTED TO BE RETURNED FOR EVAL.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR INSULIN| INSULIN INFUSION SET