BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ANIMAS INSULIN INFUSION PUMP

    MDR report key: 2210354 · Received August 12, 2011

    Report

    Report Number
    2531779-2011-05838
    Event Type
    Malfunction
    Date Received
    August 12, 2011
    Report Date
    July 15, 2011
    Manufacturer
    ANIMAS CORPORATION
    Product Code
    LZG
    PMA / PMN Number
    K042873
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, US
    Reporter Occupation
    PATIENT

    Narratives

    Additional Manufacturer Narrative · 1

    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.

    Additional Manufacturer Narrative · 1

    FOLLOW-UP #1: DATE OF SUBMISSION 09/29/2015. DEVICE EVALUATION: THE DEVICE HAS BEEN RETURNED AND EVALUATED BY PRODUCT ANALYSIS ON 09/11/2015 WITH THE FOLLOWING FINDINGS: DURING A VISUAL INSPECTION OF THE KEYPAD, IT WAS NOTED THAT ALL OF THE BUTTONS WERE WORN. ALL OF THE BUTTONS ON THE KEYPAD WERE INTERMITTENTLY RESPONSIVE. THE KEYPAD COVER WAS REMOVED AND ALL OF THE BUTTON CONTACTS HAD CONTAMINATION UNDERNEATH THEM. UNRELATED TO THE ORIGINAL COMPLAINT IT WAS NOTED THAT THE DISPLAY WAS DIM AND DISCOLORED WHEN POWERED ON.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE KEYPAD BUTTON PRESSES DID NOT ACTIVATE DESIRED PUMP FUNCTIONS. THE REPORTER CLAIMED THE DOWN ARROW KEYPAD REQUIRED ADDITIONAL PRESSES WITH MORE FORCE TO RESPOND. THERE WAS NO REPORTED PATIENT IMPACT ASSOCIATED WITH THIS COMPLAINT.

    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 9 YR