FDA Adverse Event Malfunction Summary report: N

T:SLIM X2 INSULIN PUMP

MDR report key: 9395406 · Received December 2, 2019

Report

Report Number
3013756811-2019-85461
Event Type
Malfunction
Date Received
December 2, 2019
Date of Event
November 17, 2019
Report Date
December 2, 2019
Manufacturer
TANDEM DIABETES CARE
Product Code
OYC
PMA / PMN Number
P140015
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CA
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

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 A MALFUNCTION ALARM OCCURRED. CUSTOMER'S BLOOD GLUCOSE LEVEL WAS 102-103 MG/DL. REPORTEDLY, THE MALFUNCTION WAS CLEARED AND INSULIN DELIVERIES RESUMED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1192869 T:SLIM X2 INSULIN PUMP PUMP, INFUSION, INSULIN, TO BE USED WITH INVASIVE GLUCOSE SENSOR OYC TANDEM DIABETES CARE 1002717

Patients

Seq Age Sex Outcome Treatment
1 10 YR