FDA Adverse Event Malfunction Summary report: N

ONETOUCHPING GLUCOSEMGMTSYSTEM

MDR report key: 3925590 · Received July 10, 2014

Report

Report Number
2531779-2014-19526
Event Type
Malfunction
Date Received
July 10, 2014
Report Date
July 5, 2014
Manufacturer
ANIMAS CORPORATION
Product Code
LZG
PMA / PMN Number
K080639
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
IA, 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

DEVICE EVALUATION: THE PUMP HAS BEEN RETURNED AND EVALUATED BY PRODUCT ANALYSIS ON (B)(4) 2014 WITH THE FOLLOWING FINDINGS: VISUAL INSPECTION REVEALED THAT THE AUDIO BOLUS BUTTON WAS MISSING. THERE WAS EVIDENCE OF CORROSION OBSERVED ON THE AUDIO BOLUS BUTTON CONTACTS. A LEAK TEST WAS PERFORMED AND A LEAK WAS FOUND AT THE MISSING AUDIO BOLUS BUTTON. THE PUMP CASE WAS REMOVED AN NO EVIDENCE OF MOISTURE WAS FOUND INSIDE THE PUMP. UNRELATED TO THE COMPLAINT, EVALUATION REVEALED THAT THE BATTERY COMPARTMENT WAS CRACKED FROM THE CASE SEAL TO THE GRIP PAD. ALSO UNRELATED TO THE COMPLAINT, EVALUATION REVEALED THAT THE DISPLAY WAS FADED AND DISCOLORED.

Description of Event or Problem · 1

ON (B)(6) 2014, THE REPORTER CONTACTED ANIMAS, ALLEGING A BUTTON/KEYPAD (ABB DMG PRIOR TCTL CNG W/MOIST) ISSUE. THE REPORTER ALLEGED THAT THE AUDIO BOLUS BUTTON WAS MISSING/PEELING. ADDITIONALLY, MOISTURE/CORROSION WAS EVIDENT IN THE AUDIO BOLUS BUTTON AREA AND BEHIND THE DISPLAY. 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
405050 ONETOUCHPING GLUCOSEMGMTSYSTEM INSULIN INFUSION PUMP LZG ANIMAS CORPORATION

Patients

Seq Age Sex Outcome Treatment
1 14 YR