MAUDE Adverse Event Report: BIGFOOT BIOMEDICAL,.INC BIGFOOT UNITY DIABETES MANAGEMENT SYSTEM

Model Number	FG-300206
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Fatigue (1849); Hypoglycemia (1912); Confusion/ Disorientation (2553)
Date of Event	09/07/2022
Type of Reportable Event	Serious Injury
Event or Problem Description
Customer reported symptoms of hypoglycemia including dis-orientation and tiredness on (b)(6) 2022.The customer did not treat their hypoglycemic event.The customer stated that they received low glucose alerts from the bigfoot unity system.There was no report of the customer requiring third party assistance or medical intervention.
Additional Manufacturer Narrative
No allegation against the system was reported by the customer.Bigfoot conducted a thorough investigation and there was no indication that the product did not meet specification.Review of the data logs show that the system issued low glucose alerts per specification and some alerts were acknowledged by the customer.After acknowledgement or resolution of an alert, the system re-issued low glucose alerts per specification when the customer's glucose reached low and very low levels.If bigfoot learns of any new information in relation to this case, another investigation will be performed, and a follow-up report will be submitted.All pertinent information available to bigfoot has been submitted.

• Brand Name: BIGFOOT UNITY DIABETES MANAGEMENT SYSTEM
• Common Device Name: DIABETES MANAGEMENT SYSTEM
• Manufacturer (Section D): BIGFOOT BIOMEDICAL,.INC; 1820 mc carthy boulevard; milpitas CA 95035
• Manufacturer (Section G): BIGFOOT BIOMEDICAL,.INC; 1820 mc carthy boulevard; milpitas CA 95035
• Manufacturer Contact: kate lee ; 1820 mc carthy boulevard; milpitas, CA 95035 ; 4087165600
• MDR Report Key: 18104220
• Report Number: 3016525500-2022-00017
• Device Sequence Number: 5428522
• Product Code: QLG
• UDI-Device Identifier: 00850003506401
• UDI-Public: 0100850003506401
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: K202145
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 10/06/2022

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
• Operator of Device: Lay User/Patient
• Device Model Number: FG-300206
• Device Catalogue Number: FG-300206
• Device Lot Number: 20310
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/08/2022
• Initial Report FDA Received Date: 11/09/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 08/31/2022
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other
• Patient Age: 41 YR
• Patient Sex: Unknown