BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ANIMAS INSULIN INFUSION PUMP

    MDR report key: 2160020 · Received July 13, 2011

    Report

    Report Number
    2531779-2011-04887
    Event Type
    Malfunction
    Date Received
    July 13, 2011
    Date of Event
    May 26, 2011
    Report Date
    June 14, 2011
    Manufacturer
    ANIMAS CORPORATION
    Product Code
    LZG
    PMA / PMN Number
    K042873
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). DEVICE EVALUATION: THE PUMP HAS BEEN RETURNED AND EVALUATED BY PRODUCT ANALYSIS ON (B)(4) 2011 WITH THE FOLLOWING FINDINGS: DURING EVALUATION THE PUMP WAS ABLE TO REWIND, LOAD AND PRIME SUCCESSFULLY. A REVIEW OF THE PUMP HISTORY DID NOT INDICATE THAT LOSS OF CARTRIDGE DETECTION HAD OCCURRED. UNRELATED TO THE EVENT THE DISPLAY LENS WAS FOUND TO HAVE A LEAK. MOISTURE WAS OBSERVED UNDER THE DISPLAY LENS, AND THE DISPLAY WAS FOUND TO HAVE A RED TINT.

    Additional Manufacturer Narrative · 1

    (B)(4). THE PUMP HAS NOT BEEN RETURNED TO ANIMAS FOR EVALUATION. ANIMAS HAS CONDUCTED A REVIEW OF THE DEVICE HISTORY RECORD FOR THIS PUMP AND CONFIRMED THAT IT WAS OPERATING WITHIN REQUIRED SPECIFICATIONS AT THE TIME OF RELEASE. IF THE DEVICE IS RETURNED, AN EVALUATION SHALL BE COMPLETED AND A SUPPLEMENTAL REPORT WILL BE FILED. NO CONCLUSIONS CAN BE MADE AT THIS TIME.

    Description of Event or Problem · 1

    THE PATIENT STATED THAT THE PUMP DID NOT DETECT THE CARTRIDGE ON THE LOAD STEP. THERE WAS NO EVIDENCE OF MISUSE OF THE PRODUCT AND THE ISSUE WAS NOT RESOLVED THROUGH TROUBLESHOOTING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ANIMAS INSULIN INFUSION PUMP INSULIN INFUSION PUMP LZG ANIMAS CORPORATION ANM 2020 INSULIN INFUSION PUMP

    Patients

    Seq Age Sex Outcome Treatment
    1