BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    QUICK SET PARADIGM

    MDR report key: 1522101 · Received November 2, 2009

    Report

    Report Number
    8021545-2009-00025
    Event Type
    Malfunction
    Date Received
    November 2, 2009
    Date of Event
    July 2, 2009
    Report Date
    October 28, 2009
    Manufacturer
    UNOMEDICAL A/S
    Product Code
    FPA
    PMA / PMN Number
    K991759
    Removal / Correction Number
    Z-1705-2009
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    TWO USED DEVICES WERE RETURNED FOR EVALUATION. THE TUBING WAS VISUALLY INSPECTED FOR ANY TEARS OR CRACKS ON THE TUBING IT SELF AND ON THE ATTACHED CONNECTOR PARTS. FURTHERMORE A FLOW TEST AND A P-CAP CONNECTOR VENT TEST WERE PERFORMED. THE MEMBRANES IN THE P-CAP CONNECTOR WERE HUMID AND BOTH SAMPLES ALSO FAILED THE P-CAP CONNECTOR VENT TEST AND THE FLOW TEST OF THE TUBING. THE REFERENCE MATERIAL WAS TESTED AND FOUND TO BE WITHIN SPECIFICATIONS. A REVIEW OF THE RELEVANT DEVICE HISTORY RECORDS AND A SEARCH FOR RELEVANT DEVIATIONS OR SIMILAR COMPLAINTS RELATED TO THE SPECIFIC DEVICE RESULTED IN NO SIMILAR COMPLAINTS FOR THE INVOLVED LOT NUMBER 8200863. NO RELEVANT DEVIATIONS DURING MANUFACTURING WERE RECORDED.

    Description of Event or Problem · 1

    PATIENT STATES THAT INSULIN CONTINUES TO SQUIRT OUT OF INFUSION SET TUBING AFTER PRIMING PROCESS HAS STOPPED ACCORDING TO INFUSION PUMP. THE FLOW OF INSULIN CONTINUES FOR ABOUT 15-20 SECONDS. PATIENT CHANGED INFUSION SET FROM INVOLVED LOT NUMBER TO A NEW SET FROM LOT NUMBER 2208980 AND PROBLEM WAS RESOLVED. MALFUNCTION OCCURRED PRIOR TO USE. UNOMEDICAL RECEIVED THE COMPLAINT THROUGH (B) (4), THE DISTRIBUTOR OF THE INFUSION SET. (B) (4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 QUICK SET PARADIGM FPA UNOMEDICAL A/S MMT-398 8200863

    Patients

    Seq Age Sex Outcome Treatment
    1 NA