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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ELI LILLY AND COMPANY HUMAPEN, UNKNOWN DEVICE FOR TREATMENT PURPOSES

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ELI LILLY AND COMPANY HUMAPEN, UNKNOWN DEVICE FOR TREATMENT PURPOSES Back to Search Results
Model Number UNKNOWN
Device Problems Mechanical Problem (1384); No Flow (2991)
Patient Problems Hyperglycemia (1905); No Code Available (3191)
Event Type  Injury  
Manufacturer Narrative
If device is returned, evaluation will be performed to determine if a malfunction has occurred. This is an initial report. A follow-up report will be submitted when the final evaluation is completed.
 
Event Description
Lilly case id: (b)(4) this report is associated with product complaint: (b)(4). This spontaneous case, reported by consumer who contacted the company to report adverse events and product complaint (pc), concerned a male patient of unknown age and origin. Medical history (complication, allergy history, family history), previous drug adverse reaction, family drug reaction and concomitant medication were not provided. The patient received insulin lispro protamine suspension 75%/insulin lispro 25% (rdna origin) injections (humalog mix 25, 100u/ml) from cartridge via reusable device (humapen unknown device, color black-as reported), for the treatment of diabetes mellitus, beginning on an unknown date. Dosage regimen was not provided. On an unknown date, after starting insulin lispro protamine suspension 75%/insulin lispro 25% therapy, he experienced that her blood glucose value was very high (pre-prandial blood glucose value was 15 and postprandial blood glucose value was 25, no units or reference were provided) and diabetes mellitus. In about 2017, he was hospitalised due to diabetic hyperglycemia for 20-30 days. On (b)(6) 2020, the black injection screw of the injection pen could not move, injection button could not be pressed down and medicinal liquid could not flow out (pc (b)(4) / lot number unknown). On an unknown date, he had complications of diabetes which were ear not working, eye not working, haemorrhage at the bottom of the eye. The event of haemorrhage at the bottom of the eye was considered serious due to its medical significance. Information regarding corrective treatment, outcome for the events and status of insulin lispro protamine suspension 75%/insulin lispro 25% therapy was not provided. The operator of the humapen unknown device and his/her training status were not provided. The model humapen unknown device duration of use was not provided. The suspect humapen unknown device duration of use was approximately three years as it was started since 2017. The use of the suspect humapen unknown device was ongoing and its return status was not provided. The reporting consumer did not know if the events were related to the insulin lispro protamine suspension 75%/insulin lispro 25% therapy and did not provide a relatedness assessment for the events to suspect humapen unknown device. Edit 23jul2020: updated medwatch and (b)(6) and (b)(6) fields for expedited device reporting. No new information added.
 
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Brand NameHUMAPEN, UNKNOWN DEVICE
Type of DeviceFOR TREATMENT PURPOSES
Manufacturer (Section D)
ELI LILLY AND COMPANY
lilly corporate center
indianapolis, in
Manufacturer Contact
chris davis
lilly corporate center
indianapolis, 
4334585
MDR Report Key10332447
MDR Text Key208971491
Report Number1819470-2020-00094
Device Sequence Number1
Product Code FMF
Combination Product (y/n)N
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type consumer,foreign
Type of Report Initial,Followup
Report Date 08/14/2020
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received07/28/2020
Is this an Adverse Event Report? Yes
Device Operator Other
Device Model NumberUNKNOWN
Was Device Available for Evaluation? No
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received08/12/2020
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial

Patient Treatment Data
Date Received: 07/28/2020 Patient Sequence Number: 1
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