FDA Adverse Event Malfunction Summary report: N

ONETOUCHPING GLUCOSEMGMTSYSTEM

MDR report key: 4100378 · Received September 18, 2014

Report

Report Number
2531779-2014-26704
Event Type
Malfunction
Date Received
September 18, 2014
Report Date
September 6, 2014
Manufacturer
ANIMAS CORPORATION
Product Code
LZG
PMA / PMN Number
K080639
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
FL, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

THE PUMP HAS BEEN RETURNED AND EVALUATED BY PRODUCT ANALYSIS ON (B)(4) 2014 WITH THE FOLLOWING FINDINGS: EVALUATION REVEALED THAT THE PUMP BOOTS TO VERIFY SCREEN WITH VIBRATORY AND AUDIBLE FEATURES. AN EZPRIME SEQUENCE AND 24HR DURATION TEST WERE SUCCESSFULLY COMPLETED. THE TOTAL DAILY DOSE ADDS UP CORRECTLY. NO ERRORS, ALARMS OR WARNINGS RELATED TO THE COMPLAINT IN PUMP HISTORY. PUMP SUCCESSFULLY COMPLETED A DELIVERY ACCURACY TEST AND WAS FOUND TO BE DELIVERING WITHIN SPECIFICATION. PATIENT NEGLIGENCE ISSUE - PUMP SUBJECTED TO CONDITIONS OUTSIDE SPECIFICATION. THE PUMP IS NOT DETECTING THE CORRECT FORCE AT 5 POUNDS. REMOVED COVER AND DISASSEMBLED PUMP AND THE FORCE SENSOR RESISTANCE WAS FOUND TO BE IN SPECIFICATIONS. NO EVIDENCE OF CONTAMINATION FOUND IN FORCE SENSOR HOUSING. THE BATTERY COMPARTMENT IS CRACKED BETWEEN BUMPER GRIP AND CASE SEAL. RETURNED BATTERY CAP IS ABLE TO FULLY ATTACH TO THE PUMP AND USER USED TO COMPLETE ALL TESTING. (B)(6).

Description of Event or Problem · 1

THE PUMP WAS RETURNED FOR INVESTIGATION. INVESTIGATION REVEALED A CRACKED BATTERY COMPARTMENT AND THE PUMP IS NOT DETECTING CORRECT FORCE. 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
580158 ONETOUCHPING GLUCOSEMGMTSYSTEM INSULIN INFUSION PUMP LZG ANIMAS CORPORATION

Patients

Seq Age Sex Outcome Treatment
1 72 YR