FDA Adverse Event Malfunction Summary report: N

T:SLIM X2 INSULIN PUMP WITH CONTROL-IQ TECHNOLOGY

MDR report key: 12917406 · Received December 2, 2021

Report

Report Number
3013756811-2021-130474
Event Type
Malfunction
Date Received
December 2, 2021
Date of Event
November 18, 2021
Report Date
December 2, 2021
Manufacturer
TANDEM DIABETES CARE
Product Code
QFG
PMA / PMN Number
K201214
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CA
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

DEVICE NOT RETURNED.

Description of Event or Problem · 0

IT WAS REPORTED THAT INTERMITTENT CARTRIDGE ALARMS OCCURRED DURING BASAL INSULIN DELIVERY AND DURING THE LOAD SEQUENCE WITH MULTIPLE CARTRIDGES. CUSTOMER'S BLOOD GLUCOSE RANGED FROM 102-103 MG/DL. THE CUSTOMER REVERTED TO MANUAL INJECTIONS FOR INSULIN THERAPY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1815924 T:SLIM X2 INSULIN PUMP WITH CONTROL-IQ TECHNOLOGY ALTERNATE CONTROLLER ENABLED INFUSION PUMP QFG TANDEM DIABETES CARE 1002717 6029013

Patients

Seq Age Sex Outcome Treatment
1 27 YR Female