BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ANIMAS INSULIN INFUSION PUMP

    MDR report key: 2233089 · Received September 2, 2011

    Report

    Report Number
    2531779-2011-06443
    Event Type
    Malfunction
    Date Received
    September 2, 2011
    Report Date
    June 8, 2011
    Manufacturer
    ANIMAS CORPORATION
    Product Code
    LZG
    PMA / PMN Number
    K042873
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    PATIENT

    Narratives

    Additional Manufacturer Narrative · 1

    CORRECTION NUMBER: 2531779-03/24/2010-003-R. DEVICE EVALUATION: THE PUMP HAS BEEN RETURNED AND EVALUATED BY PRODUCT ANALYSIS ON 08/05/2011 WITH THE FOLLOWING FINDINGS: THERE WERE NO LOAD STEP MALFUNCTIONS NOTED IN THE PUMP HISTORY. DURING TESTING, THE PUMP PUSHED ALL THE FLUID OUT OF THE CARTRIDGE AND EMITTED A "NO CARTRIDGE DETECTED" WARNING. DURING EVALUATION THE FORCE SENSOR WAS FOUND TO BE OUT OF CALIBRATION. THERE WAS EVIDENCE OF CONTAMINATION OBSERVED ON THE FORCE SENSOR PLATE. 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.

    Description of Event or Problem · 1

    THE PUMP WAS RETURNED FOR LARGE PRIME VOLUME. EVALUATION REVEALED THAT THE FORCE SENSOR WAS OUT OF CALIBRATION AND THERE WAS CONTAMINATION ON THE FORCE SENSOR PLATE. THIS REPORT IS MADE BASED ON RESULTS OF INVESTIGATION COMPLETED ON 08/05/2011.

    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 20 YR