BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK SPIRIT COMBO

    MDR report key: 3052165 · Received April 11, 2013

    Report

    Report Number
    2183996-2013-00650
    Event Type
    Malfunction
    Date Received
    April 11, 2013
    Date of Event
    April 8, 2013
    Report Date
    May 31, 2013
    Product Code
    LZG
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    THE INCIDENT OCCURRED OUTSIDE THE UNITED STATES. INFORMATION CONTAINED WITHIN THIS REPORT IS ALL THAT IS AVAILABLE AT THIS TIME. IF FURTHER INFORMATION IS OBTAINED, IT WILL BE PROVIDED IN THE SUPPLEMENTAL REPORT.

    Additional Manufacturer Narrative · 1

    THE CHECK BUTTON DOES NOT RESPOND. THERE ARE PARTICLES INSIDE THE HOUSING OF THE CHECK BUTTON. THE PARTICLES ISOLATE THE AREA OF CONTACT INSIDE THE BUTTON HOUSING. DUE TO THIS PROBLEM THE CHECK BUTTON DOES NOT RESPOND AND IS WITHOUT FUNCTION.

    Description of Event or Problem · 1

    ON (B)(6) 2013, IT WAS REPORTED THAT OCCASIONALLY AFTER COMING INTO CONTACT WITH WATER THE CHECK BUTTON ON THE PATIENT'S INFUSION DEVICE WOULD NOT FUNCTION AND SOMETIMES THE DEVICE WOULD SHUT OFF BY ITSELF. NO PHYSIOLOGICAL EFFECTS WERE REPORTED. THE PATIENT DID NOT REQUIRE MEDICAL ASSISTANCE FROM A HEALTHCARE PROFESSIONAL OR SECOND PARTY TO ADDRESS THE ISSUE. THE INFUSION DEVICE WAS REQUESTED TO BE RETURNED FOR PRODUCT EVALUATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    155205 ACCU-CHEK SPIRIT COMBO INSULIN INFUSION DEVICE LZG 00700006863 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 048 YR