BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK SPIRIT

    MDR report key: 2172423 · Received June 17, 2011

    Report

    Report Number
    2183996-2011-01804
    Event Type
    Malfunction
    Date Received
    June 17, 2011
    Date of Event
    June 1, 2010
    Report Date
    June 1, 2011
    Manufacturer
    ROCHE INSULIN DELIVERY SYSTEMS INC.
    Product Code
    LZG
    PMA / PMN Number
    K060876
    Removal / Correction Number
    Z-1415-2009
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GA, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    ON (B)(6) 2011, THE PT REPORTED THE DOWN BUTTON OF HER INFUSION DEVICE DOES NOT WORK. THIS BEGAN ABOUT A YEAR AGO. SHE STATED THE BUTTON DOES NOT RESPOND TO HER PRESS AND WOULD NOT "GO IN." SHE PRESSED THE BUTTON SEVERAL TIMES AND IT WOULD GO DOWN AND THEN POP BACK OUT. NO PHYSIOLOGICAL EFFECTS WERE REPORTED. 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 SYSTEMS INC. NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 45 YR INSULIN| INSULIN INFUSION SET