MAUDE Adverse Event Report: MIO; UNO INSET II 80/6 SC1 GREY MCAN

Model Number	MMT-965A600
Medical Device Problem Code	Material Twisted/Bent (2981)
Health Effect - Clinical Code	Hyperglycemia (1905)
Type of Reportable Event	Serious Injury
Event or Problem Description
Unomedical reference number (b)(4).Event occurred in (b)(6).On (b)(6) 2022, the patient's mother reported that her son faced a bent cannula due to which he experienced high blood glucose level (33.3 mmol/l) within the last 2 weeks and this issue occurred with five infusion sets.Her son reported this issue to her 2-3 days ago.The site location was patient's abdomen and buttock.Moreover, the infusion sets have been used for same day, first day and for second day.Unomedical do not see bent/kinking as being related to human factors, but rather as a training issue including correct choices of insertion sites and infusion sets and cannula length.Furthermore, the soft cannula is a flexible material that during use and upon removal can bend slightly.No further information available.

• Brand Name: MIO
• Common Device Name: UNO INSET II 80/6 SC1 GREY MCAN
• Manufacturer Contact: aaholmvej 1-3; osted; lejre, 4320
• MDR Report Key: 15630429
• Report Number: 3003442380-2022-01066
• Device Sequence Number: 20825696
• Product Code: FPA
• UDI-Device Identifier: 05705244020399
• UDI-Public: 05705244020399
• Combination Product (Y/N): Y
• PMA/510(K) Number: K160648
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Distributor
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 10/19/2022

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?: No
• Device Expiration Date: 09/01/2024
• Device Model Number: MMT-965A600
• Device Lot Number: 5366477
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/14/2022
• Initial Report FDA Received Date: 10/19/2022
• Patient Sequence Number: 1
• Patient Sex: Unknown