FDA Adverse Event Malfunction Summary report: N

ONETOUCHPING GLUCOSEMGMTSYSTEM

MDR report key: 3882112 · Received June 18, 2014

Report

Report Number
2531779-2014-17502
Event Type
Malfunction
Date Received
June 18, 2014
Report Date
June 15, 2014
Manufacturer
ANIMAS CORPORATION
Product Code
LZG
PMA / PMN Number
K080639
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
OH, 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

(B)(4) DEVICE EVALUATION: THE PUMP HAS BEEN RETURNED AND EVALUATED BY PRODUCT ANALYSIS ON 07/14/2014 WITH THE FOLLOWING FINDINGS: VISUAL INSPECTION OF THE PUMP FOUND SOME COSMETIC DAMAGES. MOISTURE AND CORROSION WERE OBSERVED IN THE DISPLAY AND INFRARED COMMUNICATION PORT. A LEAK TEST SHOWED A LEAK AT THE DISPLAY LENS. THE PUMP POWERED UP WITH THE APPROPRIATE AUDIBLE AND VIBRATORY FEATURES. THE DISPLAY SCREEN WAS DIM AND MULTI-COLORED. THE KEYPAD BUTTONS WERE NOT RESPONDING TO USER INPUT. THE INVESTIGATION WAS UNABLE TO COMPLETE THE REMAINING TESTING. THE PUMP CASING WAS OPENED AND MOISTURE CORROSION WAS FOUND THROUGHOUT THE PUMP INTERIOR.

Description of Event or Problem · 1

ON (B)(6) 2014, THE REPORTER CONTACTED ANIMAS, ALLEGING A DISPLAY (BLANK SCREEN W/MOISTURE) ISSUE. REPORTEDLY, THE DISPLAY WAS DIM AND MOISTURE WAS OBSERVED IN THE BATTERY COMPARTMENT. IT WAS NOTED THAT PUMP REBOOT DID NOT RESOLVE THE DISPLAY 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
358321 ONETOUCHPING GLUCOSEMGMTSYSTEM INSULIN INFUSION PUMP LZG ANIMAS CORPORATION

Patients

Seq Age Sex Outcome Treatment
1 12 YR