MAUDE Adverse Event Report: ABBOTT DIABETES CARE INC FREESTYLE LIBRE PRO; FLASH GLUCOSE MONITORING SYSTEM

Model Number	71562-01
Medical Device Problem Code	Appropriate Device Problem Term/Code Not Available (3191)
Health Effect - Clinical Codes	Purulent Discharge (1812); Erythema (1840); Unspecified Infection (1930); Skin Irritation (2076); Swelling (2091)
Date of Event	02/18/2019
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
The product has been requested back for an investigation.A follow-up report will be submitted once additional information is obtained.The device mfg date is unknown.The date is the date abbott diabetes care became aware of the event.All pertinent information available to abbott diabetes care has been submitted.Common device name - corrected from the initial 30-day report.
Event or Problem Description
An hcp reported a customer experienced an allergic skin reaction on day 3 of wear of the adc freestyle libre pro sensor.The customer presented with "redness and bumps" just on her right arm and self-treated with benadryl, claritin and hydrocortisone cream.A couple of days later, the redness and bumps from the right upper arm had spread and "weeping yellowish" discharge was noted.The customer had hcp contact and was administered an injection of the steroid, kenalog (dose unknown,) and was given a prescription for augmentin (amoxicillin, dose unknown) for treatment.There was no report of death or permanent injury associated with this event.
Additional Manufacturer Narrative
This serves as a correction report.Emdr-62656 (2954323-2019-03773) was submitted in error as in initial and should have been created as a supplemental for a correction related to mdr # emdr-57314 (2954323-2019-02333).
Event or Problem Description
An hcp reported a customer experienced an allergic skin reaction on day 3 of wear of the adc freestyle libre pro sensor.The customer presented with "redness and bumps" just on her right arm and self-treated with benadryl, claritin and hydrocortisone cream.A couple of days later, the redness and bumps from the right upper arm had spread and "weeping yellowish" discharge was noted.The customer had hcp contact and was administered an injection of the steroid, kenalog (dose unknown,) and was given a prescription for augmentin (amoxicillin, dose unknown) for treatment.There was no report of death or permanent injury associated with this event.

• Brand Name: FREESTYLE LIBRE PRO
• Common Device Name: FLASH GLUCOSE MONITORING SYSTEM
• Manufacturer (Section D): ABBOTT DIABETES CARE INC; 1360 south loop road; alameda CA 94502 7001
• MDR Report Key: 8596675
• Report Number: 2954323-2019-03773
• Device Sequence Number: 1981942
• Product Code: MDS
• UDI-Device Identifier: 00357599715625
• UDI-Public: 00357599715625
• Combination Product (Y/N): N
• Initial Reporter State: UT
• Initial Reporter Country: US
• PMA/510(K) Number: P150021
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: health professional
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 06/28/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Lay User/Patient
• Device Model Number: 71562-01
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 05/09/2019
• Supplement Date Received by Manufacturer: 06/28/2019
• Initial Report FDA Received Date: 05/09/2019
• Supplement Report FDA Received Date: 06/28/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Weight: 120