FDA Adverse Event
Malfunction
Summary report: N
T:SLIM X2, BASAL-IQ, MMOL/L
MDR report key: 11529619
·
Received March 19, 2021
Report
- Report Number
- 3013756811-2021-29074
- Event Type
- Malfunction
- Date Received
- March 19, 2021
- Date of Event
- February 25, 2021
- Report Date
- March 19, 2021
- Manufacturer
- TANDEM DIABETES CARE
- Product Code
- OZO
- PMA / PMN Number
- K201214
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- CA
- Reporter Occupation
- OTHER
Narratives
Additional Manufacturer Narrative · 1
NO PRODUCT WAS RETURNED FOR EVALUATION. SHOULD NEW RELEVANT INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.
Description of Event or Problem · 1
IT WAS REPORTED THAT MULTIPLE OCCLUSION ALARMS OCCURRED. CUSTOMER CHANGED THE PUMP SUPPLIES MULTIPLE TIMES TO RESOLVE THE OCCLUSION. CUSTOMER'S BLOOD GLUCOSE WAS 251-398 MG/DL.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 422257 | T:SLIM X2, BASAL-IQ, MMOL/L | AUTOMATED INSULIN DOSING, THRESHOLD SUSPEND | OZO | TANDEM DIABETES CARE | 1002717 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 54 YR |