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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: AUTOSOFT XC; UNO INSET I 60/9 GREY TCAP 10PK INT

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AUTOSOFT XC; UNO INSET I 60/9 GREY TCAP 10PK INT Back to Search Results
Model Number 1001681
Device Problem Material Twisted/Bent (2981)
Patient Problem Diabetic Ketoacidosis (2364)
Event Type  Injury  
Event Description
Unomedical reference number (b)(4).Event occurred in the united states.It was reported that the patient experienced high blood glucose level due to a bent cannula on the infusion site.Therefore, he tried to treat it with a bolus via pump, but on (b)(6) 2021, the patient went to the emergency room and was consequently hospitalized due to high blood glucose level.Further, he was admitted to intensive care unit.His highest blood glucose level was 900 mg/dl and had high ketone level.Moreover, the infusion had been used for one day.During hospitalization, he received fluids of saline, insulin, and unspecified intravenous medication (drug name unknown) which resolved the issue.On (b)(6) 2021, the patient was released with no permanent damage.Unomedical do not see bent/kinking as being related to human factors, but rather as a training issue including correct choices of insertion sites and infusion sets and cannula length.Furthermore, the soft cannula is a flexible material that during use and upon removal can bend slightly.No further information available.
 
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Brand Name
AUTOSOFT XC
Type of Device
UNO INSET I 60/9 GREY TCAP 10PK INT
Manufacturer Contact
aaholmvej 1-3
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lejre, 4320
MDR Report Key12106035
MDR Text Key259637415
Report Number3003442380-2021-00310
Device Sequence Number1
Product Code FPA
UDI-Device Identifier05705244016651
UDI-Public05705244016651
Combination Product (y/n)Y
PMA/PMN Number
K032854
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type distributor
Type of Report Initial
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received07/02/2021
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator No Information
Device Model Number1001681
Device Lot NumberUNKNOWN
Date Manufacturer Received06/24/2021
Type of Device Usage N
Patient Sequence Number1
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