BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ANIMAS INSULIN INFUSION PUMP

    MDR report key: 3770203 · Received April 24, 2014

    Report

    Report Number
    2531779-2014-11242
    Event Type
    Malfunction
    Date Received
    April 24, 2014
    Date of Event
    February 3, 2014
    Report Date
    April 9, 2014
    Manufacturer
    ANIMAS CORPORATION
    Product Code
    LZG
    PMA / PMN Number
    K042873
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE PUMP HAS NOT BEEN RETURNED TO ANIMAS FOR EVALUATION. 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. (B)(6).

    Additional Manufacturer Narrative · 1

    (B)(4). DEVICE EVALUATION: THE DEVICE HAS BEEN RETURNED AND EVALUATED BY PRODUCT ANALYSIS ON (B)(4) 2014 WITH THE FOLLOWING FINDINGS: THE UP ARROW, DOWN ARROW, AND OK BUTTONS HAD AN INTERMITTENT RESPONSE AND REQUIRED MULTIPLE BUTTON PRESSES TO BECOME ENGAGED. THE CONTRAST BUTTON WAS RESPONSIVE. THERE WAS NO VISIBLE DAMAGE TO THE KEYPAD. CONTAMINATION WAS FOUND UNDER THE UP ARROW, DOWN ARROW, AND OK BUTTON CONTACTS WHEN THE KEYPAD WAS REMOVED. UNRELATED TO THE ORIGINAL COMPLAINT, THE TEXT ON THE DISPLAY SCREEN WAS DIM AND DISCOLORED. THE CONTRAST SETTING WAS INCREASED TO THE MAXIMUM WITH LITTLE IMPROVEMENT OBSERVED.

    Description of Event or Problem · 1

    ON (B)(6) 2014, THE DISTRIBUTOR CONTACTED ANIMAS, ALLEGING A BUTTON/KEYPAD (TACTILE CHANGES/UNRESPONSIVE) ISSUE. 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
    249178 ANIMAS INSULIN INFUSION PUMP INSULIN INFUSION PUMP LZG ANIMAS CORPORATION

    Patients

    Seq Age Sex Outcome Treatment
    1