BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ONETOUCHPING GLUCOSEMGMTSYSTEM

    MDR report key: 3980689 · Received August 5, 2014

    Report

    Report Number
    2531779-2014-22422
    Event Type
    Malfunction
    Date Received
    August 5, 2014
    Report Date
    July 24, 2014
    Manufacturer
    ANIMAS CORPORATION
    Product Code
    LZG
    PMA / PMN Number
    K080639
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    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

    FOLLOW-UP #1: DATE OF SUBMISSION 03/10/2015. DEVICE EVALUATION: THE DEVICE HAS BEEN RETURNED AND EVALUATED BY PRODUCT ANALYSIS ON 02/18/2015 WITH THE FOLLOWING FINDINGS: BATTERY COMPARTMENT CRACK OBSERVED IN THREAD AREA AND BELOW GRIP PAD. EVIDENCE OF MOISTURE CONTAMINATION INSIDE BATTERY COMPARTMENT. DUE TO MOISTURE CONTAMINATION PUMP IS UNRESPONSIVE, NO AUDIBLE TONE, NO VIBRATION AND A BLANK DISPLAY WITH BOTH THE RETURNED BATTERY CAP AND A TEST BATTERY CAP. INVESTIGATORS WERE UNABLE TO ADEQUATELY INVESTIGATE LOSS OF PRIME COMPLAINT DUE TO UNRESPONSIVE PUMP. THERE WAS EVIDENCE OF ADDITIONAL MOISTURE CONTAMINATION INSIDE OF PUMP. 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.

    Description of Event or Problem · 1

    ON (B)(6) 2014, THE REPORTER CONTACTED ANIMAS, ALLEGING A PRIME (LOSS OF PRIME) 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
    457756 ONETOUCHPING GLUCOSEMGMTSYSTEM INSULIN INFUSION PUMP LZG ANIMAS CORPORATION

    Patients

    Seq Age Sex Outcome Treatment
    1 38 YR