FDA Adverse Event
Malfunction
Summary report: N
TANDEM T: SLIM INSULIN DELIVERY SYSTEM
MDR report key: 4223575
·
Received August 5, 2014
Report
- Report Number
- 3007981285-2014-03869
- Event Type
- Malfunction
- Date Received
- August 5, 2014
- Date of Event
- June 6, 2014
- Report Date
- July 6, 2014
- Manufacturer
- TANDEM DIABETES CARE INC.
- Product Code
- LZG
- PMA / PMN Number
- K111210
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- PA, US
- Reporter Occupation
- NOT APPLICABLE
Narratives
Additional Manufacturer Narrative · 1
NO PRODUCT RETURNING FOR EVALUATION. SHOULD NEW INFORMATION BECOME AVAILABLE; A FOLLOW UP REPORT WILL BE SUBMITTED.
Description of Event or Problem · 1
RECEIVED INFORMATION STATING CUSTOMER RECEIVED MULTIPLE OCCLUSION ALARMS. THERE WAS NO REPORTED IMPACT TO CUSTOMER'S BLOOD GLUCOSE LEVEL.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 458627 | TANDEM T: SLIM INSULIN DELIVERY SYSTEM | INSULIN PUMP | LZG | TANDEM DIABETES CARE INC. | 004628 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 16 YR | INSULIN: NOVOLOG| INFUSION SET: INSET 23 |