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

Model Number 14000

Device Problem Insufficient Information (3190)

Patient Problems Abdominal Pain (1685); Fever (1858); Hyperglycemia (1905); Virus (2136); Vomiting (2144); Diabetic Ketoacidosis (2364)

Event Date 01/12/2020

Event Type  Injury  

Manufacturer Narrative

The device was not returned for evaluation.We are unable to determine if any product condition could have contributed to the reported hospitalization and diabetic ketoacidosis.No lot release records were reviewed, as the product lot number was not provided.Omnipod insulin management system ¿ user guide, model: ust400, 17845-5a-aw rev b 09/17.Checking your blood glucose chapter 4 / page 36: warnings: test results below 70 mg/dl mean low blood glucose (hypoglycemia).Test results greater than 250 mg/dl mean high blood glucose (hyperglycemia).If you get results below 70 mg/dl or above 250 mg/dl, but do not have symptoms of hypoglycemia or hyperglycemia (see "living with diabetes" on page 115), repeat the test.If you have symptoms or continue to get results that fall below 70 mg/dl or above 250 mg/dl, follow the treatment advice of your healthcare provider.Checking your blood glucose chapter 4 / page 42: warning: blood glucose readings that are especially low or high can indicate potentially serious condition requiring immediate medical attention.If left untreated, this situation can quickly lead to diabetic ketoacidosis (dka), shock, coma, or death.Living with diabetes chapter 11 / page 119: avoid lows, highs, and dka: you can avoid most risks related to using the omnipod® system by practicing proper techniques and by acting promptly at the first sign of hypoglycemia, hyperglycemia, or diabetic ketoacidosis.The easiest and most reliable way to avoid these conditions is to check your blood glucose often.Living with diabetes chapter 11 / page 126: warnings: if left untreated, dka can cause breathing difficulties, shock, coma, and eventually death.If you need emergency attention, ask a friend or family member to take you to the emergency room or call an ambulance.Do not drive yourself.To avoid dka: the easiest and most reliable way to avoid dka is by checking your blood glucose at least 4¿6 times a day.Routine checks allow you to identify and treat high blood glucose before dka develops.

Event Description

It was reported that the patient had been hospitalized with diabetic ketoacidosis (dka) but the acting doctor feels that there may be an underlying virus going on.The patient stated that he was not feeling well since the previous day with a slight fever, chest pain and vomiting the patient's blood glucose levels reached 309 mg/dl while wearing the pod longer than 48 hours.The patient was treated with intravenous fluids of insulin.The patient was also given a computed tomography (ct) scan as well as a chest x-ray to detect any underlying virus.The pod was discarded at the hospital.The patient stated there were no medications prescribed as he is still in hospital.

• Brand Name: OMNIPOD INSULIN PUMP
• Type of Device: PUMP, INFUSION, INSULIN
• Manufacturer (Section D): INSULET CORPORATION; 100 nagog park; acton MA 01720
• Manufacturer (Section G): INSULET CORPORATION; 100 nagog park; acton MA 01720
• Manufacturer Contact: jordan biswurm ; 100 nagog park; acton, MA 01720 ; 9786007000
• MDR Report Key: 9687999
• MDR Text Key: 178744820
• Report Number: 3004464228-2020-01713
• Device Sequence Number: 1
• Product Code: LZG
• UDI-Device Identifier: 20385081120002
• UDI-Public: (01)20385081120002
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K122953
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: consumer
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 01/15/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 02/10/2020
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Lay User/Patient
• Device Model Number: 14000
• Device Catalogue Number: ZXP425
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 01/15/2020
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Hospitalization; Required Intervention
• Patient Age: 36 YR