FDA Adverse Event
Malfunction
Summary report: N
T:SLIM X2 INSULIN PUMP WITH BASAL-IQ TECHNOLOGY
MDR report key: 9351216
·
Received November 20, 2019
Report
- Report Number
- 3013756811-2019-85781
- Event Type
- Malfunction
- Date Received
- November 20, 2019
- Date of Event
- November 2, 2019
- Report Date
- November 20, 2019
- Manufacturer
- TANDEM DIABETES CARE
- Product Code
- OZO
- UDI-DI
- 00853052007264
- PMA / PMN Number
- P180008
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- CA, US
- Reporter Occupation
- OTHER
Narratives
Additional Manufacturer Narrative · 1
PER TANDEM USER GUIDE: "ONLY USE HUMALOG® OR NOVOLOG® U-100 INSULIN, AS ANY LESSER OR GREATER CONCENTRATION CAN RESULT IN SERIOUS HEALTH CONSEQUENCES." NO PRODUCT WAS RETURNED FOR EVALUATION. SHOULD NEW RELEVANT INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.
Description of Event or Problem · 1
IT WAS REPORTED THAT THE CARTRIDGE WAS "CLOGGED." REPORTEDLY THE CUSTOMER WAS USING FIASP INSULIN. TANDEM TECHNICAL SUPPORT INFORMED CUSTOMER ABOUT INSULIN LABELING. THE CUSTOMER'S BLOOD GLUCOSE LEVEL RANGED FROM 200-279 MG/DL AND NO ADDITIONAL INFORMATION WAS PROVIDED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1141908 | T:SLIM X2 INSULIN PUMP WITH BASAL-IQ TECHNOLOGY | AUTOMATED INSULIN DOSING, THRESHOLD SUSPEND | OZO | TANDEM DIABETES CARE | 1000096 | 00853052007264 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 72 YR |