BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TANDEM T:SLIM INSULIN DELIVERY SYSTEM

    MDR report key: 4102284 · Received September 17, 2014

    Report

    Report Number
    3007981285-2014-08320
    Event Type
    Malfunction
    Date Received
    September 17, 2014
    Date of Event
    August 8, 2014
    Report Date
    August 18, 2014
    Manufacturer
    TANDEM DIABETES CARE INC.
    Product Code
    LZG
    PMA / PMN Number
    K111210
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MI, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THE DEVICE HAS BEEN RECEIVED FOR EVALUATION. HOWEVER, DEVICE EVALUATION IS NOT YET COMPLETE. A SUPPLEMENTAL REPORT WILL BE SUBMITTED UPON COMPLETION OF EVALUATION.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE TOUCHSCREEN DISPLAY IS SHATTERED AND PIXILATED AFTER THE PUMP WAS DROPPED. NO IMPACT TO CUSTOMER'S BLOOD GLUCOSE LEVEL. THE DEVICE IS A DEMO PUMP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    576595 TANDEM T:SLIM INSULIN DELIVERY SYSTEM INSULIN PUMP LZG TANDEM DIABETES CARE INC. 004628

    Patients

    Seq Age Sex Outcome Treatment
    1