BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OMNIPOD INSULIN PUMP

    MDR report key: 2071801 · Received April 21, 2011

    Report

    Report Number
    3004464228-2011-00169
    Event Type
    Injury
    Date Received
    April 21, 2011
    Date of Event
    August 21, 2010
    Report Date
    March 28, 2011
    Manufacturer
    INSULET CORPORATION
    Product Code
    LZG
    PMA / PMN Number
    K042792
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THE POD WAS THOROUGHLY EVALUATED AND NO EVIDENCE OF ANY MALFUNCTION OR MFG DEFICIENCY WAS FOUND THAT WOULD HAVE DIRECTLY CAUSED OR CONTRIBUTED TO THE CUSTOMER'S HIGH BG LEVELS. AN AIR BUBBLE, HOWEVER, WAS FOUND WITHIN THE POD'S INSULIN RESERVOIR. THIS TYPICALLY OCCURS WHEN AIR IS INTRODUCED INTO THE POD DURING THE FILL PROCESS AND IS NOT RELATED TO ANY MFG PROCESS ISSUE OR PRODUCT DEFECT. THE OMNIPOD'S USER GUIDE INSTRUCTS USERS ON PROPER FILLING TECHNIQUE AND INCLUDES THE FOLLOWING WARNING: "NEVER INJECT AIR INTO THE FILL PORT. DOING SO MAY RESULT IN UNINTENDED OR INTERRUPTED INSULIN DELIVERY." INTERRUPTED INSULIN DELIVERY HAS THE POTENTIAL TO RESULT IN HIGH BLOOD GLUCOSE LEVELS. "USER ERROR", THEREFORE, IS CONSIDERED TO BE A CONTRIBUTING FACTOR TO THE CUSTOMER'S REPORTED HIGH BG LEVELS. INSULET HAS INITIATED AN INTERNAL INVESTIGATION TO DETERMINE IF MARKETING CAN IMPROVE EDUCATION AND TRAINING RELATED TO THIS TOPIC. THE INVESTIGATION IS IN-PROCESS AS OF THE DATE OF THIS REPORT.

    Description of Event or Problem · 1

    THE CUSTOMER'S MOTHER CALLED TO REPORT THAT HER SON EXPERIENCED HIGH BG LEVELS WHILE WEARING THE POD. (NO SPECIFIC LEVELS WERE PROVIDED, BUT BG'S GREATER THAN 250MG/DL ARE ASSUMED.) NO SPECIFIC POD ISSUE WAS REPORTED. NO ADD'L INFO ABOUT THE DEVICE OR THE EVENT WAS PROVIDED. A REQUEST FOR AN UPDATE WAS MADE BUT NOT RECEIVED TO DATE. THE POD WILL BE RETURNED FOR EVAL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 OMNIPOD INSULIN PUMP PUMP, INFUSION, INSULIN LZG INSULET CORPORATION 11200 L30343

    Patients

    Seq Age Sex Outcome Treatment
    1 17 YR Other