MAUDE Adverse Event Report: QUICK SET PARADIGM; UNO QUICK-SET 110/9 PCC MECA

Lot Number 5404525

Device Problem Detachment of Device or Device Component (2907)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Type  malfunction  

Event Description

Unomedical reference number (b)(4) event occurred in china on (b)(6) 2024, it was reported that patient's infusion set's tubing was detached.Reportedly, the pump was dropped with the set connected to patient's body.No further information available.

• Brand Name: QUICK SET PARADIGM
• Type of Device: UNO QUICK-SET 110/9 PCC MECA
• Manufacturer Contact: aaholmvej 1-3; osted; lejre, 4320
• MDR Report Key: 18892694
• MDR Text Key: 337527574
• Report Number: 3003442380-2024-00188
• Device Sequence Number: 1
• Product Code: FPA
• UDI-Device Identifier: 05705244006775
• UDI-Public: 05705244006775
• Combination Product (y/n): N
• PMA/PMN Number: K160648
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Distributor
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 03/13/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Lot Number: 5404525
• Initial Date Manufacturer Received: 03/07/2024
• Initial Date FDA Received: 03/13/2024
• Patient Sequence Number: 1