BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ANIMAS INSULIN INFUSION PUMP

    MDR report key: 3924519 · Received July 9, 2014

    Report

    Report Number
    2531779-2014-19487
    Event Type
    Malfunction
    Date Received
    July 9, 2014
    Report Date
    June 17, 2014
    Manufacturer
    ANIMAS CORPORATION
    Product Code
    LZG
    PMA / PMN Number
    K042873
    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 (B)(4) 2014 WITH THE FOLLOWING FINDINGS: THE KEYPAD COVER WAS TORN FROM THE OK TO UP BUTTONS. ALL OF THE KEYPAD BUTTONS RESPONDED INTERMITTENTLY. CONTAMINATION WAS FOUND UNDERNEATH ALL OF THE KEYPAD BUTTONS. ADDITIONALLY, THE BATTERY COMPARTMENT WAS CRACKED AT THE THREADS. ALSO, THE DISPLAY WAS DIM AND DISCOLORED. 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. (B)(6).

    Description of Event or Problem · 1

    THE PUMP WAS RETURNED FOR INVESTIGATION. INVESTIGATION REVEALED UNRESPONSIVE KEYPAD BUTTONS WITH CONTAMINATION PRESENT ON THE KEYPAD CONTACTS, A DIM AND DISCOLORED DISPLAY SCREEN, AND A CRACK ON THE BATTERY COMPARTMENT. THIS REPORT IS MADE BASED ON RESULTS OF INVESTIGATION COMPLETED ON (B)(4) 2014.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    402088 ANIMAS INSULIN INFUSION PUMP INSULIN INFUSION PUMP LZG ANIMAS CORPORATION

    Patients

    Seq Age Sex Outcome Treatment
    1