BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    AUTOSOFT 90

    MDR report key: 19729978 · Received July 12, 2024

    Report

    Report Number
    3003442380-2024-13737
    Event Type
    Malfunction
    Date Received
    July 12, 2024
    Date of Event
    April 22, 2024
    Report Date
    July 10, 2024
    Manufacturer
    UNOMEDICAL A/S
    Product Code
    FPA
    UDI-DI
    05705244018181
    PMA / PMN Number
    K032854
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    003

    Narratives

    Additional Manufacturer Narrative · 0

    INITIAL AND FINAL MDR 1910290 - MDR 3003442380-2024-13737 - DEVICE 1 OF 3.

    Description of Event or Problem · 0

    UNOMEDICAL REFERENCE NUMBER (B)(4). EVENT OCCURRED IN THE UNITED STATES. ON 22-APR-2024, IT WAS REPORTED THAT THE PATIENT FACED INFUSION SET FELL OFF DURING USE. THE INFUSION SET WAS IN USE FOR COUPLE OF HOURS. THE PATIENT REPLACED INFUSION SET AND RESUMED INSULIN SUCCESSFULLY. NO FURTHER INFORMATION AVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2384558 AUTOSOFT 90 UNO INSET II 60/9 GREY TCAP 10PK INT FPA UNOMEDICAL A/S 1002819 6003477 05705244018181

    Patients

    Seq Age Sex Outcome Treatment
    1 48 YR Male