BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ONETOUCHPING GLUCOSEMGMTSYSTEM

    MDR report key: 3497673 · Received December 3, 2013

    Report

    Report Number
    2531779-2013-22745
    Event Type
    Malfunction
    Date Received
    December 3, 2013
    Report Date
    November 19, 2013
    Manufacturer
    ANIMAS CORPORATION
    Product Code
    LZG
    PMA / PMN Number
    K080639
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    PATIENT

    Narratives

    Additional Manufacturer Narrative · 1

    THE PUMP HAS BEEN RETURNED AND EVALUATED BY PRODUCT ANALYSIS ON 11/19/2013 WITH THE FOLLOWING FINDINGS: A REVIEW OF THE PUMP HISTORY SHOWED MULTIPLE CALL SERVICE ALARMS HAD OCCURRED. EVALUATION REVEALED THAT A COMPONENT ON THE PRINTED CIRCUIT BOARD HAD FAILED. (B)(6).

    Description of Event or Problem · 1

    THE PUMP WAS RETURNED FOR INVESTIGATION. INVESTIGATION REVEALED THAT A COMPONENT ON THE PRINTED CIRCUIT BOARD HAD FAILED. THERE WAS NO ADVERSE EVENT ASSOCIATED WITH THIS COMPLAINT. THIS REPORT IS MADE BASED ON RESULTS OF INVESTIGATION COMPLETED ON 11/19/2013.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    626104 ONETOUCHPING GLUCOSEMGMTSYSTEM INSULIN INFUSION PUMP LZG ANIMAS CORPORATION

    Patients

    Seq Age Sex Outcome Treatment
    1 21 YR