BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK SPIRIT

    MDR report key: 2943068 · Received January 18, 2013

    Report

    Report Number
    2183996-2012-02122
    Event Type
    Malfunction
    Date Received
    January 18, 2013
    Date of Event
    July 16, 2012
    Report Date
    July 16, 2012
    Manufacturer
    ROCHE HLTH SOLUTIONS, INC.
    Product Code
    LZG
    PMA / PMN Number
    NA
    Removal / Correction Number
    Z-1646-2009
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    RS
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THIS INCIDENT OCCURRED OUTSIDE OF 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 A SUPPLEMENTAL REPORT.

    Description of Event or Problem · 1

    THE PT REPORTED AN ISSUE WITH THE UP/DOWN BUTTON OF THE INFUSION DEVICE. NO SERIOUS INJURY WAS REPORTED. THE INFUSION DEVICE WAS REQUESTED TO BE RETURNED FOR EVALUATION. EVALUATION OF THE DEVICE FOUND THAT THE UP/DOWN BUTTON WAS DEFECTIVE. DURING A TELECONFERENCE ((B)(6) 2012) WITH PERSONNEL FROM THE OSB, A REQUEST WAS MADE TO SUBMIT MEDWATCH REPORTS FOR ALL OUS COMPLAINTS RELATED TO THE ACCU-CHECK SPIRIT RECALL (Z-1646-2009) RECEIVED AFTER CLOSURE OF THE RECALL ON 07/03/2012.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    28408 ACCU-CHEK SPIRIT LZG ROCHE HLTH SOLUTIONS, INC. 00700006862 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 RELATED ACEESSORIES| INSULIN INFUSION PUMP| INSULIN