BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCU-CHEK ® SPIRIT COMBO

    MDR report key: 3103256 · Received May 9, 2013

    Report

    Report Number
    2183996-2013-00829
    Event Type
    Malfunction
    Date Received
    May 9, 2013
    Date of Event
    May 6, 2013
    Report Date
    June 18, 2013
    Manufacturer
    ROCHE DIABETES CARE AG
    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

    THIS 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 COMPLAINT CANNOT BE VERIFIED DUE TO CARELESS HANDLING OF THE PRODUCT. E8 POWER INTERRUPT ERRORS WERE FOUND IN THE HISTORY LIST. THE SOFT COMPONENT OF THE UP BUTTON IS DAMAGED AND RESTRICTED HANDLING OF THE PUMP IS A POSSILE IMPLICATION. DUE TO THE LEAKY SOFT COMPONENT, LIQUID ENTERED THE PUMP HOUSING AND DAMAGED THE FUNCTIONALITY OF THE BUTTONS. THIS CAUSED THE OTHER BUTTONS TO NOT RESPOND AND THE PUMP TO DISPLAY AN UNCLEARABLE E8 ERROR MESSAGE.

    Description of Event or Problem · 1

    PATIENT REPORTED THE INFUSION DEVICE DISPLAYED AN E8 POWER INTERRUPT ERROR, AND THE ERROR MESSAGE COULD NOT BE CLEARED DUE TO A NON- FUNCTIONAL BUTTON. THE INFUSION DEVICE WAS REQUESTED FOR EVALUATION. NO PHYSIOLOGICAL EFFECTS WERE REPORTED, AND THE PATIENT DID NOT REQUIRE TREATMENT FROM A HEALTHCARE PROFESSIONAL OR SECOND PARTY TO ADDRESS THE ISSUE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    203427 ACCU-CHEK ® SPIRIT COMBO INSULIN INFUSION PUMP LZG ROCHE DIABETES CARE AG 00700006863 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 041 YR