FDA Adverse Event Malfunction Summary report: N

ACCU-CHEK SPIRIT

MDR report key: 2143634 · Received June 3, 2011

Report

Report Number
2183996-2011-01577
Event Type
Malfunction
Date Received
June 3, 2011
Date of Event
February 10, 2011
Report Date
May 10, 2011
Manufacturer
ROCHE INSULIN DELIVERY SYSTEMS INC.
Product Code
LZG
PMA / PMN Number
K060876
Removal / Correction Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
TX, US
Reporter Occupation
UNKNOWN

Narratives

Description of Event or Problem · 1

ON (B)(6) 2011, PT REPORTED THAT SHE HAS EXPERIENCED ERRATIC BLOOD GLUCOSE OVER THE PAST 2-3 MONTHS AND THAT SHE BELIEVES THE INSULIN DELIVERY OF THE INFUSION DEVICE IS INACCURATE. PT PROVIDED AN EXAMPLE FROM (B)(6) 2011. BLOOD GLUCOSE WAS 193 MG/DL IN THE EVENING. PT DID NOT EAT DINNER AND DELIVERED 2.5 UNITS OF INSULIN THROUGH THE INFUSION DEVICE. PT WOKE ON THE MORNING OF (B)(6) 2011 WITH A BLOOD GLUCOSE OF 270 MG/DL. SHE CHANGED THE COMPETITOR'S INFUSION SET AND DELIVERED AN INSULIN INJECTION. SHE ATE LUNCH AND DELIVERED A BOLUS THROUGH THE INFUSION DEVICE, AND BLOOD GLUCOSE WAS 462 MG/DL 2 HOURS LATER. AT 11:15 P.M., BLOOD GLUCOSE WAS 142 MG/DL. SHE DELIVERED 0.5 UNITS THROUGH THE INFUSION DEVICE, AND BLOOD GLUCOSE DECREASED TO 52 MG/DL AT 3:25 A.M. ON (B)(6) 2011. PT ATE CARBOHYDRATES TO TREAT HYPOGLYCEMIA. BLOOD GLUCOSE WAS THEN 292 MG/DL WHEN SHE WOKE LATER IN THE MORNING. SHE RECEIVED AN E4 OCCLUSION ERROR ON (B)(6) 2011 AND CHANGED THE COMPETITOR'S INFUSION SET TO CLEAR IT. THERE HAS BEEN NO INSULIN POOLING AT INFUSION SITES. INFUSION DEVICE, CARTRIDGE, AND ADAPTER WERE REPLACED AND REQUESTED FOR EVAL. THE PT DID NOT REQUIRE TREATMENT FROM A HEALTH CARE PROFESSIONAL OR SECOND PARTY TO ADDRESS THE ISSUE. ADD'L ATTEMPTS WERE MADE TO FOLLOW-UP WITH PT, AND THESE WERE UNSUCCESSFUL.

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 58 YR INSULIN INFUSION SET| INSULIN