BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    T:SLIM X2 INSULIN PUMP WITH CONTROL-IQ TECHNOLOGY

    MDR report key: 12201816 · Received July 21, 2021

    Report

    Report Number
    3013756811-2021-76017
    Event Type
    Malfunction
    Date Received
    July 21, 2021
    Date of Event
    May 20, 2021
    Report Date
    July 21, 2021
    Manufacturer
    TANDEM DIABETES CARE
    Product Code
    QFG
    UDI-DI
    00850006613779
    PMA / PMN Number
    K201214
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE DEVICE HAS BEEN RECEIVED FOR EVALUATION; HOWEVER, DEVICE EVALUATION IS NOT YET COMPLETE. A SUPPLEMENTAL REPORT WILL BE SUBMITTED UPON COMPLETION OF THE EVALUATION.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE CARTRIDGE WAS LEAKING FROM THE PATIENT LINE. CUSTOMER LOADED A NEW CARTRIDGE TO ADDRESS THE ISSUE. CUSTOMER'S BLOOD GLUCOSE WAS 120-220 MG/DL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1102476 T:SLIM X2 INSULIN PUMP WITH CONTROL-IQ TECHNOLOGY ALTERNATE CONTROLLER ENABLED INFUSION PUMP QFG TANDEM DIABETES CARE 1002717 M890952 00850006613779

    Patients

    Seq Age Sex Outcome Treatment
    1 69 YR INFUSION SET: AUTOSOFT XC, INSULIN: HUMALOG