FDA Adverse Event Malfunction Summary report: N

ONE TOUCH PING GLUCOSE MANAGEMENT SYSTEM

MDR report key: 2091269 · Received April 20, 2011

Report

Report Number
2531779-2011-02732
Event Type
Malfunction
Date Received
April 20, 2011
Report Date
March 27, 2011
Manufacturer
ANIMAS CORP.
Product Code
LZG
PMA / PMN Number
K080639
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
TX, US
Reporter Occupation
UNKNOWN

Narratives

Additional Manufacturer Narrative · 1

THE PUMP HAS NOT BEEN RETURNED TO ANIMAS. IF THE DEVICE IS RETURNED, AN EVALUATION SHALL BE COMPLETED AND A SUPPLEMENTAL REPORT WILL BE FILED. NO CONCLUSION CAN BE MADE AT THIS TIME.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE OK BUTTON STOPPED WORKING THIS EVENING. THE PATIENT STATED THAT THERE IS NO VISIBLE DAMAGE TO THE KEYPAD AND THE PUMP IS REGULARLY EXPOSED TO MOISTURE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 ONE TOUCH PING GLUCOSE MANAGEMENT SYSTEM INSULIN INFUSION PUMP LZG ANIMAS CORP. ONE TOUCH PING NA

Patients

Seq Age Sex Outcome Treatment
1