BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ONETOUCHPING GLUCOSEMGMTSYSTEM

    MDR report key: 2854828 · Received December 3, 2012

    Report

    Report Number
    2531779-2012-14184
    Event Type
    Malfunction
    Date Received
    December 3, 2012
    Report Date
    November 9, 2012
    Manufacturer
    ANIMAS CORPORATION
    Product Code
    LZG
    PMA / PMN Number
    K080639
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    PATIENT

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4): CONTAMINATION WAS OBSERVED UNDER THE 'UP' 'DOWN' AND CONTRAST BUTTON CONTACTS. THE KEYPAD WAS FOUND TO BE INTACT. ALL KEYPAD BUTTONS WERE FOUND TO BE RESPONDING PROPERLY DURING EVALUATION. UNRELATED TO THE EVENT THE BOLUS BUTTON WAS FOUND TO BE MISSING AND UNRESPONSIVE.

    Description of Event or Problem · 1

    THE PUMP HAS BEEN RETURNED AND WAS EVALUATED BY PRODUCT ANALYSIS ON (B)(4) 2012 WITH THE FOLLOWING FINDINGS: CONTAMINATION WAS OBSERVED UNDER THE 'UP' 'DOWN' AND CONTRAST BUTTON CONTACTS. THIS REPORT IS BEING MADE BASED ON THE EVALUATION RESULTS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ONETOUCHPING GLUCOSEMGMTSYSTEM INSULIN INFUSION PUMP LZG ANIMAS CORPORATION ONETOUCH PING INSULIN PUMP

    Patients

    Seq Age Sex Outcome Treatment
    1 9 YR