MAUDE Adverse Event Report: UNOMEDICAL A/S UNO INSET II 60/6 PCC BLUE MIMX; MIO¿ ADVANCE

Model Number	MMT-943
Medical Device Problem Code	No Apparent Adverse Event (3189)
Health Effect - Clinical Code	Elevated ketones/Diabetic Ketoacidosis (2364)
Date of Event	07/20/2019
Type of Reportable Event	Serious Injury
Event or Problem Description
Unomedical reference number (b)(4) event occurred in the united states it was reported by mother that a 7 year old male subject had a device [possible] related adverse event with a diagnosis of severe hyperglycemia.The subject recovered without sequela on (b)(6) 2019.High glucose value of 354 mg/dl and ketones of 3.5 reported.No further information available.

• Brand Name: UNO INSET II 60/6 PCC BLUE MIMX
• Common Device Name: MIO¿ ADVANCE
• Manufacturer (Section D): UNOMEDICAL A/S; aaholmvej 1-3; osted; lejre, 4320 ; DA 4320
• Manufacturer Contact: aaholmvej 1-3; osted; lejre, 4320
• MDR Report Key: 19686715
• Report Number: 8021545-2024-01744
• Device Sequence Number: 12542068
• Product Code: FPA
• UDI-Device Identifier: 05705244007499
• UDI-Public: 05705244007499
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: K173879
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Distributor
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 07/05/2024

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: MMT-943
• Device Lot Number: UNKNOWN
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/07/2024
• Initial Report FDA Received Date: 07/07/2024
• Was Device Evaluated by Manufacturer? (Y/N): No
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Patient Age: 7 YR
• Patient Sex: Male