BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ANIMAS VIBE

    MDR report key: 6141128 · Received December 2, 2016

    Report

    Report Number
    2531779-2016-32731
    Event Type
    Malfunction
    Date Received
    December 2, 2016
    Report Date
    November 8, 2016
    Manufacturer
    ANIMAS CORPORATION
    Product Code
    LZG
    PMA / PMN Number
    P130007
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FR
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    DEVICE EVALUATION: THE PUMP HAS BEEN RETURNED AND EVALUATED BY PRODUCT ANALYSIS ON 11/08/2016 WITH THE FOLLOWING FINDINGS: INVESTIGATION REVEALED A DIM AND DISCOLORED DISPLAY. UNRELATED TO THIS, THE BOLUS BUTTON COVER WAS DETACHED/MISSING. INITIAL REPORTER: (B)(4).

    Description of Event or Problem · 1

    THE PUMP WAS RETURNED FOR INVESTIGATION. THIS REPORT IS MADE BASED ON RESULTS OF INVESTIGATION COMPLETED ON 11/08/2016. INVESTIGATION REVEALED A DIM AND DISCOLORED DISPLAY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    793897 ANIMAS VIBE INSULIN INFUSION PUMP LZG ANIMAS CORPORATION

    Patients

    Seq Age Sex Outcome Treatment
    1