BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TANDEM T:SLIM INSULIN DELIVERY SYSTEMS

    MDR report key: 3874977 · Received June 2, 2014

    Report

    Report Number
    3007981285-2014-00894
    Event Type
    Injury
    Date Received
    June 2, 2014
    Date of Event
    May 2, 2014
    Report Date
    May 2, 2014
    Manufacturer
    TANDEM DIABETES
    Product Code
    LZG
    PMA / PMN Number
    K111210
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OK, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    NO PRODUCT RETURNING FOR EVALUATION. ATTEMPTS WERE MADE TO OBTAIN ALL AVAILABLE INFORMATION. SHOULD NEW INFORMATION BECOME AVAILABLE, A FOLLOW UP MDR WILL BE SUBMITTED.

    Description of Event or Problem · 1

    RECEIVED INFORMATION STATING CUSTOMER RECEIVED MULTIPLE OCCLUSION ALARMS. THE CUSTOMER'S BLOOD GLUCOSE LEVEL WAS IMPACTED. REPORTEDLY, THE CUSTOMER CHANGED OUT CARTRIDGE INFUSION SET AND INSULIN, STATING THAT IT WAS TIME TO DO SO, AND BLOOD GLUCOSE LEVEL IMPROVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    321862 TANDEM T:SLIM INSULIN DELIVERY SYSTEMS INSULIN PUMP LZG TANDEM DIABETES 004628

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Other INFUSION SET: CONTACT DETACH| INSULIN: NOVOLOG