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Adverse Event Report

ELI LILLY AND COMPANY HUMAPEN ERGO, BURG/CLEAR PEN INJECTOR   back to search results
Model Number MS8930
Device Problem Component(s), broken
Event Type  Malfunction  
Event Description

Information report: this device case, reported by a consumer (via a company representative) and concerns the consumer who was receiving humulin m2 (20/80) and humulin n (nph) via a pen injector device (humapen ergo). Indication for use unspecified. The device was operated by the patient. The patient was a trained user. The patient had used the device for nine months in 2001. The patient's medical history was not provided. It was unknown whether the patient was receiving any concomitant medications. In nov-2001, it was reported by the patient that patient's humapen ergo (lot# a1509/ model#ms8930) 'footpad broke off and the injection screw does not advance'. The humapen was returned to the company for analysis. Initial inspection of the returned device revealed: detached footpad and two broken engagement tabs. The patient's humapen was replaced. The returned humapen was forwarded to the manufacturer (pds for analysis during november 2001. No adverse event was reported in connection with this complaint. The device was returned to the manufacturer (pds) for analysis. The manufacturer's evaluation results revealed: the suspected root cause for the device failure is post-production abuse from the field. The part damage is consistent with the engagement tabs being trimmed with a sharp knife. Review of house samples and fmea's was not warranted due to the nature of the device failure. The failure mode observed on this device is substantially different from the failure mode observed for the opaque cartridge holder tabs, which usually exhibited a brittle failure surface consistent with a sustained stress fracture and crack propagation.

 
Manufacturer Narrative

Results/conclusions: initial qc analysis results: detached footpad and two broken engagement tabs. Manufacturer (pds) analysis results: the suspected root cause for the device failure is post-production abuse from the field. The part damage is consistent with the engagement tabs being trimmed with a sharp knife. Review of house samples and fmea's was not warranted due to the nature of the device failure. The failure mode observed on this device is substantially different from the failure mode observed for the opaque cartridge holder tabs, which ususally exhibited a brittle failure surface consistent with a sustained stress fracture and crack propagation.

 
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Brand NameHUMAPEN ERGO, BURG/CLEAR
Type of DevicePEN INJECTOR
Baseline Brand NameHUMAPEN ERGO, BURG/CLEAR
Baseline Generic NamePEN INJECTOR
Baseline Catalogue NumberNI
Baseline Model NumberMS8930
Baseline Device 510(K) Number
Baseline Device PMA Number
Manufacturer (Section F)
ELI LILLY AND COMPANY
lilly corporate center
indianapolis IN 46285
Manufacturer (Section D)
ELI LILLY AND COMPANY
lilly corporate center
indianapolis IN 46285
Manufacturer Contact
lilly corporate center
indianapolis , IN 46285
(317) 276 -7788
Device Event Key353434
MDR Report Key364327
Event Key343460
Report Number1819470-2001-00059
Device Sequence Number1
Product CodeKZE
Report Source Manufacturer
Source Type Foreign,Consumer,Company Representative
Reporter Occupation NO INFORMATION
Type of Report Initial
Report Date 11/05/2001
1 Device Was Involved in the Event
1 Patient Was Involved in the Event
Date FDA Received12/03/2001
Is This An Adverse Event Report? No
Is This A Product Problem Report? Yes
Device Operator Lay User/Patient
Device MODEL NumberMS8930
Device LOT NumberA1509
Was Device Available For Evaluation? Device Returned To Manufacturer
Date Returned to Manufacturer11/05/2001
Is The Reporter A Health Professional? No
Was the Report Sent to FDA? No
Date Manufacturer Received11/21/2001
Was Device Evaluated By Manufacturer? No Answer Provided
Is The Device Single Use? No
Is the Device an Implant? No
Is this an Explanted Device?
Type of Device Usage Reuse

Database last updated on January 30, 2009

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