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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: UNOMEDICAL A/S INSET GUARD; SET, ADMINISTRATION, INTRAVASCULAR

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UNOMEDICAL A/S INSET GUARD; SET, ADMINISTRATION, INTRAVASCULAR Back to Search Results
Model Number MMT-431AH
Medical Device Problem Code Complete Blockage (1094)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 03/23/2026
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
Patient country: canada.Patient city: (b)(6).Based on the available information, this event is deemed to be a reportable malfunction.To date no additional information has been received.Should additional information become available, a follow-up report will be submitted.Fda registration number.Reporting site: 8021545.Manufacturing site: 8021545.
 
Event or Problem Description
It was reported that the patient experienced an insulin flow blocked alarm due to occlusion event on (b)(6) 2026, where insulin does not exit the tubing through plunger push.The blockage is located in the tubing.
 
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Brand Name
INSET GUARD
Common Device Name
SET, ADMINISTRATION, INTRAVASCULAR
Manufacturer (Section D)
UNOMEDICAL A/S
aaholmvej 1 - 3
osted
lejre 4320
DA  4320
Manufacturer (Section G)
UNOMEDICAL A/S
aaholmvej 1 - 3
osted
lejre 4320
DA   4320
Manufacturer Contact
courtney smith
aaholmvej 1 - 3
osted
lejre 4320
DA   4320
6032470255
MDR Report Key24924228
Report Number8021545-2026-86243
Device Sequence Number9248123
Product Code FPA
UDI-Device Identifier05705244023161
UDI-Public05705244023161
Combination Product (Y/N)N
Initial Reporter StateCA
Initial Reporter CountryCA
PMA/510(K) Number
K210544
Number of Events Summarized1
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) 03/24/2026
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 Model NumberMMT-431AH
Device Lot Number6016260
Was Device Available for Evaluation? No
Was the Report Sent to FDA? No
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 03/24/2026
Initial Report FDA Received Date04/20/2026
Was Device Evaluated by Manufacturer? (Y/N) No
Date Device Manufactured11/01/2025
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 A
Patient Sequence Number1
Patient SexUnknown
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