FDA Adverse Event Malfunction Summary report: N

ONETOUCHPING GLUCOSEMGMTSYSTEM

MDR report key: 3844955 · Received June 3, 2014

Report

Report Number
2531779-2014-15573
Event Type
Malfunction
Date Received
June 3, 2014
Report Date
May 28, 2014
Manufacturer
ANIMAS CORPORATION
Product Code
LZG
PMA / PMN Number
K080639
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
IA, US
Reporter Occupation
PATIENT

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.

Additional Manufacturer Narrative · 1

FOLLOW-UP #1 DATE OF SUBMISSION 07/17/2014-PRODUCT ANALYSIS:THE PUMP WAS RETURNED AND EVALUATED BY PRODUCT ANALYSIS ON 07/09/2014 WITH THE FOLLOWING FINDINGS:THE KEYPAD WAS FOUND TO BE PEELING. EVALUATION REVEALED THAT THE OK AND DOWN KEYPAD BUTTONS WERE INTERMITTENTLY RESPONSIVE. THERE WAS NO EVIDENCE OF KEYPAD CONTAMINATION FOUND UNDER THE KEY CONTACTS. CORROSION WAS OBSERVED ON THE KEYPAD FLEX CABLE. UNRELATED TO THE COMPLAINT, A DISPLAY LENS LEAK WAS DISCOVERED DURING LEAK TESTING. ANIMAS HAS CONDUCTED A REVIEW OF THE DEVICE HISTORY RECORD FOR THIS PUMP AND CONFIRMED THAT IT WAS OPERATING WITHIN REQUIRED SPECIFICATIONS AT THE TIME OF RELEASE.

Description of Event or Problem · 1

ON (B)(6) 2014, THE REPORTER CONTACTED ANIMAS, ALLEGING THE KEYPAD WAS DAMAGED, THE UP, DOWN, AND OK KEYPAD BUTTONS WERE UNDER-RESPONSIVE, AND THERE WAS EVIDENCE OF MOISTURE BEHIND THE DISPLAY SCREEN LENS. IT WAS ALLEGED THAT AN UNDER-DELIVERY OF INSULIN OCCURRED. THERE WAS NO INDICATION THAT THE PRODUCT CAUSED OR CONTRIBUTED TO AN ADVERSE EVENT. THIS COMPLAINT IS BEING REPORTED BECAUSE THE REPORTED ISSUE WAS NOT RESOLVED WITH TROUBLESHOOTING.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
323615 ONETOUCHPING GLUCOSEMGMTSYSTEM INSULIN INFUSION PUMP LZG ANIMAS CORPORATION

Patients

Seq Age Sex Outcome Treatment
1 15 YR