FDA Adverse Event Malfunction Summary report: N

ONETOUCHPING GLUCOSEMGMTSYSTEM

MDR report key: 3241816 · Received July 22, 2013

Report

Report Number
2531779-2013-11638
Event Type
Malfunction
Date Received
July 22, 2013
Report Date
June 27, 2013
Manufacturer
ANIMAS CORPORATION
Product Code
LZG
PMA / PMN Number
K080639
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
NJ, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

THE PUMP HAS NOT BEEN RETURNED TO ANIMAS. 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 09/16/2013-DEVICE EVALUATION: THE PUMP HAS BEEN RETURNED AND EVALUATED BY PRODUCT ANALYSIS ON 08/28/2013 WITH THE FOLLOWING FINDINGS:DURING TESTING, THE PUMP WAS POWERED ON AND THE DISPLAY SCREEN WAS CLEAR AND LEGIBLE WITH MOISTURE OBSERVED BEHIND THE LENS. A LEAK TEST WAS PERFORMED AND A LEAK WAS FOUND DUE TO A CRACK IN THE PUMP CASE. THE PUMP CASE WAS OPENED AND MOISTURE WAS FOUND THROUGHOUT THE PUMP INTERIOR.

Description of Event or Problem · 1

ON (B)(6) 2013, THE REPORTER CONTACTED ANIMAS, ALLEGING A DISPLAY (DISPLAY ISSUE) ISSUE. THE PATIENT REPORTED SEEING MOISTURE BEHIND HALF OF THE DISPLAY SCREEN. THE PATIENT REPORTED NO CRACKS IN PUMP HOUSING OR LCD SCREEN, NO POWER LOSS, OR NO VISIBLE MOISTURE IN BATTERY COMPARTMENT; BATTERY CAP IS SECURE AND INTACT. THIS COMPLAINT IS BEING REPORTED BECAUSE THE REPORTED ISSUE WAS NOT RESOLVED WITH TROUBLESHOOTING. THERE WAS NO INDICATION THAT THE PRODUCT CAUSED OR CONTRIBUTED TO AN ADVERSE EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
340809 ONETOUCHPING GLUCOSEMGMTSYSTEM INSULIN INFUSION PUMP LZG ANIMAS CORPORATION

Patients

Seq Age Sex Outcome Treatment
1 31 YR