BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    T:SLIM X2 INSULIN PUMP WITH CONTROL-IQ TECHNOLOGY

    MDR report key: 13261550 · Received January 14, 2022

    Report

    Report Number
    3013756811-2022-00327
    Event Type
    Malfunction
    Date Received
    January 14, 2022
    Date of Event
    September 28, 2021
    Report Date
    January 14, 2022
    Manufacturer
    TANDEM DIABETES CARE
    Product Code
    QFG
    UDI-DI
    00850006613786
    PMA / PMN Number
    K201214
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TN, 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 RESISTANCE WAS FELT WHEN FILLING MULTIPLE CARTRIDGES DURING THE LOAD SEQUENCE. CUSTOMER CHANGED MULTIPLE CARTRIDGES TO RESOLVE THE ISSUE. CUSTOMER¿S BLOOD GLUCOSE WAS 110-160 MG/DL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    962472 T:SLIM X2 INSULIN PUMP WITH CONTROL-IQ TECHNOLOGY ALTERNATE CONTROLLER ENABLED INFUSION PUMP QFG TANDEM DIABETES CARE 1002717 W0102422 00850006613786

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR Female INSULIN: HUMALOG INFUSION SET: AUTOSOFT 90