BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    T:SLIM X2 INSULIN PUMP WITH BASAL-IQ TECHNOLOGY

    MDR report key: 14408305 · Received May 16, 2022

    Report

    Report Number
    3013756811-2022-51776
    Event Type
    Malfunction
    Date Received
    May 16, 2022
    Date of Event
    April 27, 2022
    Report Date
    April 27, 2022
    Manufacturer
    TANDEM DIABETES CARE
    Product Code
    OZO
    UDI-DI
    00853052007264
    PMA / PMN Number
    K201214
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OK, US
    Reporter Occupation
    OTHER
    Health Professional
    N

    Narratives

    Additional Manufacturer Narrative · 0

    THE DEVICE IS EXPECTED TO BE RETURNED; HOWEVER, THE DEVICE HAS NOT YET BEEN RECEIVED. A SUPPLEMENTAL REPORT WILL BE SUBMITTED IF THE DEVICE IS RECEIVED AND EVALUATION IS PERFORMED.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT INSULIN DRIPS WERE INTERMITTENTLY NOT OBSERVED TO BE EXITING THE INFUSION SET TUBING DURING THE LOAD FILL TUBING PROCESS. REPORTEDLY, MULTIPLE SUPPLY CHANGES WERE PERFORMED TO ADDRESS THE ISSUES; HOWEVER, THE ISSUE PERSISTED, AND THE CUSTOMER REVERTED BACK TO MANUAL DAILY INJECTIONS. CUSTOMER¿S BLOOD GLUCOSE LEVEL RANGED FROM 211-311 MG/DL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1388557 T:SLIM X2 INSULIN PUMP WITH BASAL-IQ TECHNOLOGY AUTOMATED INSULIN DOSING, THRESHOLD SUSPEND OZO TANDEM DIABETES CARE 1000096 00853052007264

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Male INSULIN: NOVOLOGINFUSION SET: AUTOSOFT 90