Brand Name | T:SLIM X2 INSULIN PUMP WITH BASAL-IQ TECHNOLOGY |
Type of Device | AUTOMATED INSULIN DOSING, THRESHOLD SUSPEND |
Manufacturer (Section D) |
TANDEM DIABETES CARE |
11075 roselle street |
san diego CA 92121 |
|
MDR Report Key | 11065738 |
MDR Text Key | 223410866 |
Report Number | 3013756811-2020-146378 |
Device Sequence Number | 1 |
Product Code |
OZO
|
UDI-Device Identifier | 00853052007264 |
UDI-Public | 00853052007264 |
Combination Product (y/n) | N |
PMA/PMN Number | K201214 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
consumer,health professional |
Type of Report
| Initial,Followup,Followup,Followup |
Report Date |
12/23/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Lay User/Patient
|
Device Model Number | 1000096 |
Device Catalogue Number | 1000886 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 02/01/2021 |
Was the Report Sent to FDA? |
Yes
|
Initial Date Manufacturer Received |
12/23/2020 |
Initial Date FDA Received | 12/23/2020 |
Supplement Dates Manufacturer Received | 12/23/2020 12/23/2020 03/10/2021
|
Supplement Dates FDA Received | 12/23/2020 12/29/2020 03/11/2021
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Treatment | INFUSION SET: TRUSTEEL; INFUSION SET: TRUSTEEL |
Patient Outcome(s) |
Hospitalization;
Required Intervention;
Disability;
|
Patient Age | 74 YR |
Patient Weight | 90 |