BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ANIMAS VIBE

    MDR report key: 6030048 · Received October 14, 2016

    Report

    Report Number
    2531779-2016-28541
    Event Type
    Malfunction
    Date Received
    October 14, 2016
    Report Date
    September 22, 2016
    Manufacturer
    DEXCOM INC.
    Product Code
    OYC
    PMA / PMN Number
    P130007
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    PATIENT

    Narratives

    Additional Manufacturer Narrative · 1

    THE PUMP HAS NOT BEEN RETURNED TO ANIMAS FOR EVALUATION. IF THE DEVICE IS RETURNED, AN EVALUATION SHALL BE COMPLETED AND A SUPPLEMENTAL REPORT WILL BE FILED. NO CONCLUSIONS CAN BE MADE AT THIS TIME.

    Additional Manufacturer Narrative · 1

    TYPE OF DEVICE CORRECTION TO OYC.

    Description of Event or Problem · 1

    ON (B)(6) 2016, THE REPORTER CONTACTED ANIMAS, ALLEGING A CGM (DEX 006) ISSUE. IT WAS REPORTED THAT THE ANT ICON APPEARED IN PLACE OF CGM READINGS FOR LESS THAN THREE HOURS [WHILE THE CGM WAS IN RANGE]. THERE WAS NO INDICATION THAT THE DEVICE CAUSED OR CONTRIBUTED TO AN ADVERSE EVENT. THIS COMPLAINT IS BEING REPORTED BECAUSE THE ISSUE MAY RESULT IN THE USER MISSING THEIR BLOOD GLUCOSE (BG) TRENDING AND FAILING TO REACT TO ANY POTENTIAL BG EXCURSIONS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    682919 ANIMAS VIBE OYC OYC DEXCOM INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 13 YR