BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    T:SLIM X2 INSULIN PUMP WITH CONTROL-IQ TECHNOLOGY

    MDR report key: 13235952 · Received January 12, 2022

    Report

    Report Number
    3013756811-2022-05960
    Event Type
    Malfunction
    Date Received
    January 12, 2022
    Date of Event
    December 30, 2021
    Report Date
    January 12, 2022
    Manufacturer
    TANDEM DIABETES CARE
    Product Code
    QFG
    UDI-DI
    00850006613793
    PMA / PMN Number
    K201214
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 0

    NO PRODUCT WAS RETURNED FOR EVALUATION. SHOULD NEW RELEVANT INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT INTERMITTENT OCCLUSION ALARMS OCCURRED. SYSTEM CHECK WAS PERFORMED AND THERE WAS A BLOCKAGE IN THE CARTRIDGE. A CARTRIDGE CHANGE RESOLVED THE ISSUE. CUSTOMER'S BLOOD GLUCOSE WAS 120-144 MG/DL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1102066 T:SLIM X2 INSULIN PUMP WITH CONTROL-IQ TECHNOLOGY ALTERNATE CONTROLLER ENABLED INFUSION PUMP QFG TANDEM DIABETES CARE 1000354 W0181870 00850006613793

    Patients

    Seq Age Sex Outcome Treatment
    1 64 YR Male INFUSION SET: AUTOSOFT 90INSULIN: HUMALOG