FDA Adverse Event
Malfunction
Summary report: N
TANDEM T:SLIM DELIVERY SYSTEM
MDR report key: 4200256
·
Received October 22, 2014
Report
- Report Number
- 3007981285-2014-10219
- Event Type
- Malfunction
- Date Received
- October 22, 2014
- Date of Event
- September 23, 2014
- Report Date
- September 25, 2014
- Manufacturer
- TANDEM DIABETES CARE INC.
- Product Code
- LZG
- PMA / PMN Number
- K111210
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- NY, US
- Reporter Occupation
- NOT APPLICABLE
Narratives
Additional Manufacturer Narrative · 1
THE PRODUCT HAS NOT BEEN RETURNED FOR EVAL. SHOULD NEW RELEVANT INFO BECOME AVAILABLE A SUPPLEMENTAL REPORT WILL BE SUBMITTED.
Description of Event or Problem · 1
IT WAS REPORTED THAT CUSTOMER RECEIVED AN ALTITUDE ALARM. THERE WAS NO IMPACT TO CUSTOMER'S BLOOD GLUCOSE LEVEL.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 673726 | TANDEM T:SLIM DELIVERY SYSTEM | INSULIN PUMP | LZG | TANDEM DIABETES CARE INC. | 004628 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 39 YR |