FDA Adverse Event Malfunction Summary report: N

ANIMAS VIBE

MDR report key: 3871705 · Received June 13, 2014

Report

Report Number
2531779-2014-16841
Event Type
Malfunction
Date Received
June 13, 2014
Report Date
June 9, 2014
Manufacturer
ANIMAS CORPORATION
Product Code
LZG
Product Problem
Yes
Report Source
Manufacturer report
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

DEVICE EVALUATION: THE PUMP HAS BEEN RETURNED AND EVALUATED BY PRODUCT ANALYSIS ON 09/04/2014 WITH THE FOLLOWING FINDINGS: A REVIEW OF THE PUMP¿S BLACK BOX HISTORY SHOWED THAT MULTIPLE CS 087 CALL SERVICE ALARMS WERE RECORDED. DURING TESTING, THE PUMP POWERED ON AND EMITTED A CS 069 CALL SERVICE ALARM, WHICH IS INDICATIVE OF AN INTERNAL COMPONENT FAILURE ON THE PRINTED CIRCUIT BOARD. THE PUMP CASE WAS REMOVED AND A COMPONENT ON THE PRINTED CIRCUIT BOARD (U39 FLASH CHIP) WAS FOUND TO BE DEFECTIVE. THE PRINTED CIRCUIT BOARD COMPONENT WAS REPLACED AND THE PUMP FUNCTIONED APPROPRIATELY WITH NO ALARMS OCCURRING DURING TESTING. NO BATTERY CAP WAS RETURNED WITH THE PUMP. A TEST BATTERY CAP WAS USED TO COMPLETE ALL 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.

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).

Description of Event or Problem · 1

ON (B)(6) 2014, THE REPORTER CONTACTED ANIMAS, ALLEGING A CALL SERVICE ALARM (CALL SERVICE ALARM ISSUE) ISSUE. IT WAS REPORTED THAT THE PUMP EMITTED A CALL SERVICE ALARM. 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
350423 ANIMAS VIBE INSULIN INFUSION PUMP LZG ANIMAS CORPORATION

Patients

Seq Age Sex Outcome Treatment
1