BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TANDEM T:SLIM INSULIN DELIVERY SYSTEM INSULIN PUMP LZG

    MDR report key: 4441045 · Received January 21, 2015

    Report

    Report Number
    3007981285-2015-18211
    Event Type
    Malfunction
    Date Received
    January 21, 2015
    Date of Event
    December 22, 2014
    Report Date
    December 22, 2014
    Manufacturer
    TANDEM DIABETES CARE INC.
    Product Code
    LZG
    PMA / PMN Number
    K111210
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AR, 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 THE EVALUATION.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE SCREEN ON QUICK BOLUS BUTTON HAS STOPPED WORKING. THE DEVICE TURNS ON WHEN PLUGGED INTO A POWER SOURCE. NO IMPACT TO CUSTOMERS' BLOOD GLUCOSE LEVEL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    48900 TANDEM T:SLIM INSULIN DELIVERY SYSTEM INSULIN PUMP LZG INSULIN PUMP LZG TANDEM DIABETES CARE INC. 004628

    Patients

    Seq Age Sex Outcome Treatment
    1 41 YR