BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TANDEM T:SLIM INSULIN DELIVERY SYSTEM

    MDR report key: 3896918 · Received May 22, 2014

    Report

    Report Number
    3007981285-2014-00793
    Event Type
    Malfunction
    Date Received
    May 22, 2014
    Date of Event
    April 22, 2014
    Report Date
    April 22, 2014
    Manufacturer
    TANDEM DIABETES
    Product Code
    LZG
    PMA / PMN Number
    K111210
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    NO PRODUCT HAS BEEN RETURNED FOR EVALUATION. SHOULD NEW INFO BECOME AVAILABLE A F/U MDR WILL BE SUBMITTED.

    Description of Event or Problem · 1

    REC'D INFO STATING PATIENT WAS EXPERIENCING HIGH BG'S (187 MG/DL). AS PER REPORTER PIGTAIL LOOKS LIKE THERE IS PRECIPITATION INSIDE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    306963 TANDEM T:SLIM INSULIN DELIVERY SYSTEM INSULIN PUMP LZG TANDEM DIABETES 004628

    Patients

    Seq Age Sex Outcome Treatment
    1 12 YR