BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK FLEXLINK PLUS

    MDR report key: 2081608 · Received April 13, 2011

    Report

    Report Number
    2183996-2011-00995
    Event Type
    Malfunction
    Date Received
    April 13, 2011
    Date of Event
    November 18, 2010
    Report Date
    March 15, 2011
    Manufacturer
    ROCHE INSULIN DELIVERY SYSTEMS INC.
    Product Code
    FRN
    PMA / PMN Number
    NA
    Removal / Correction Number
    Z-1484-2011
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    UK
    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 (VALUE NOT PROVIDED) AND KINKED INFUSION SET CANNULAS WHILE USING THE INFUSION SETS. THE PT WOULD BOLUS TO LOWER HER BLOOD GLUCOSE WITH NO SUCCESS. SHE WOULD THEN CHANGE THE INFUSION SET TO LOWER HER BLOOD GLUCOSE. SHE WOULD NOTICE THE ISSUE WITHIN 2-3 HOURS OF USE. SHE USED THE INSERTION DEVICE TO INSERT THE HEADSET. SHE ALSO REPORTED, THE ADHESIVE OF THE INFUSION SETS DID NOT STICK WELL. 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 SET WAS REQUESTED TO BE RETURNED FOR EVAL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACCU-CHEK FLEXLINK PLUS INSULIN INFUSION SET FRN ROCHE INSULIN DELIVERY SYSTEMS INC. NA GWX049

    Patients

    Seq Age Sex Outcome Treatment
    1 INSULIN INFUSION PUMP| INSULIN