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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: INSULET CORPORATION OMNIPOD INSULIN PUMP PUMP, INFUSION, INSULIN

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INSULET CORPORATION OMNIPOD INSULIN PUMP PUMP, INFUSION, INSULIN Back to Search Results
Model Number 14000
Device Problem Insufficient Information
Event Date 07/30/2015
Event Type  Injury  
Manufacturer Narrative

The product was not returned for evaluation. We are unable to determine if any product malfunction or other product condition could have contributed to the reported hyperglycemia and er visit. Lot release records were reviewed and the product lot met all acceptance criteria. The omnipod¿s user guide warns "test results greater than 250 mg/dl mean high blood glucose (hyperglycemia). If you get results above 250 mg/dl, but do not have symptoms of hyperglycemia, repeat the test. If you have symptoms or continue to get results above 250 mg/dl, follow the treatment advice of your healthcare provider.

 
Event Description

The patient's father reported that his child had to go to the er due to heavy breathing, lack of appetite and weakness. At the hospital his child was diagnosed with high blood glucose and was treated with an intravenous therapy of insulin.

 
Manufacturer Narrative

The returned product was evaluated and performed as designed during testing. No malfunction or other product condition that would have contributed to the patient's hyperglycemia and hospitalization was found.

 
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Brand NameOMNIPOD INSULIN PUMP
Type of DevicePUMP, INFUSION, INSULIN
Manufacturer (Section D)
INSULET CORPORATION
600 technology park drive
suite 200
billerica MA
Manufacturer (Section G)
INSULET CORPORATION
600 technology park drive suit
billerica MA
Manufacturer Contact
david simard
600 technology park drive
suite 200
billerica , MA 
9786007000
MDR Report Key5022087
Report Number3004464228-2015-00596
Device Sequence Number1
Product CodeLZG
Report Source Manufacturer
Source Type CONSUMER,FOREIGN
Reporter Occupation
Type of Report Initial,Followup
Report Date 08/03/2015
1 Device Was Involved in the Event
1 Patient Was Involved in the Event
Date FDA Received08/21/2015
Is This An Adverse Event Report? Yes
Is This A Product Problem Report? No
Device Operator LAY USER/PATIENT
Device EXPIRATION Date09/01/2016
Device MODEL Number14000
Device Catalogue NumberZXP425
Device LOT NumberL41640
Was Device Available For Evaluation? Device Returned To Manufacturer
Date Returned to Manufacturer08/12/2015
Is The Reporter A Health Professional? No
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received07/30/2015
Was Device Evaluated By Manufacturer? Device Not Returned To Manufacturer
Date Device Manufactured03/15/2015
Is The Device Single Use? Yes
Is this a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial

Patient TREATMENT DATA
Date Received: 08/21/2015 Patient Sequence Number: 1
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