BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ANIMAS INSULIN INFUSION PUMP

    MDR report key: 3062751 · Received April 17, 2013

    Report

    Report Number
    2531779-2013-04395
    Event Type
    Malfunction
    Date Received
    April 17, 2013
    Date of Event
    January 23, 2013
    Report Date
    March 20, 2013
    Manufacturer
    ANIMAS CORPORATION
    Product Code
    LZG
    PMA / PMN Number
    K042873
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    PATIENT

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). DEVICE EVALUATION: THE INSULIN PUMP HAS BEEN RETURNED AND ADDITIONAL INVESTIGATION WAS PERFORMED BY PRODUCT ANALYSIS ON (B)(4) 2013 WITH THE FOLLOWING FINDINGS: ON INVESTIGATION THE DISPLAY WAS NOTED TO BE DIM, FADED AND PINK. THE DISPLAY LENS WAS NOTED TO BE MISSING.

    Description of Event or Problem · 1

    THERE IS NO ADVERSE EVENT ASSOCIATED WITH THIS COMPLAINT. THIS REPORT IS MADE BASED ON RESULTS OF INVESTIGATION COMPLETED ON (B)(6) 2013: THE DISPLAY LENS WAS MISSING AND THE DISPLAY ILLUMINATION WAS DIM, FADED AND PINK.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    166501 ANIMAS INSULIN INFUSION PUMP INSULIN INFUSION PUMP LZG ANIMAS CORPORATION

    Patients

    Seq Age Sex Outcome Treatment
    1