MAUDE Adverse Event Report: UNOMEDICAL DEVICES S.A DE C.V INSET II; SET, ADMINISTRATION, INTRAVASCULAR

Model Number	MMT-975
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	06/26/2021
Type of Reportable Event	Death
Additional Manufacturer Narrative
Unomedical hereby submits this initial report as part of its complaint remediation activities conducted under a capa 2356421 and capa 2566479 in accordance with the fda action plan, which incorporates qp-ic-2026-0020 (ic retrospective complaint review) and qp-ic-2026-0024 (ic retrospective mdr review).This submission includes a retrospective reassessment of previously evaluated complaints.Unomedical is providing this supplemental information in accordance with the reporting requirements set forth in 21 cfr part 803.Additional information - this medical device report (mdr) is being submitted to include the below: h6: investigation results under type of investigation, investigation findings, investigation conclusions.H11: investigation summary.Complaint investigation results: a complaint investigation was performed based on the event description and no malfunction based on complaint information.Additional information was requested to support the investigation; however, a lot number or any product specific information was not provided.No device, device components, or other visual or physical evidence was made available for evaluation.Consequently, visual inspection, retain sample testing, or the assessment of potential product performance issues, component integrity, or manufacturing defects could not be performed.In response to the complaint and due to the absence of a specific lot number, a high-level review of manufacturing controls for the inset ii (minimed mio p cap) product family was conducted to document the routine controls used to detect potential defects at the product family level.The review identified the following controls in use for the inset ii (minimed mio p cap) product family, including: 100% leak and flow testing during final assembly.100% visual inspections during packaging, verifying needle condition, tyvek seal integrity, contamination free condition, and correct assembly.Sampling verification under acceptable quality limit aql (b)(4), including visual and functional tests such as: burst test.Peel test, flow and leak tests, static tension test.Visual inspections for cannula, tubing, lid, heat shrink and assembly integrity.Corrective and preventive action capa determination: based on the investigation, no further action is required.The record will be closed and monitored through tracking and trending per work instruction (monthly trips and alerts).Complaint investigation conclusion: based on the limited information available, the investigation was completed and no product malfunction was alleged or identified.The complaint could not be confirmed due to insufficient information, and the record is being closed based on the event description and the information provided in the complaint.Based on the available information, this event is deemed to be a death.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: 3003442380.
Event or Problem Description
It was reported that the patient has passed away due to an unknown reason on (b)(6) 2021.

• Brand Name: INSET II
• Common Device Name: SET, ADMINISTRATION, INTRAVASCULAR
• Manufacturer (Section D): UNOMEDICAL DEVICES S.A DE C.V; ave.fomento industrial l9 m3; parque industrial del norte; reynosa,tamps. 88736 ; MX 88736
• Manufacturer (Section G): UNOMEDICAL DEVICES S.A DE C.V; ave.fomento industrial l9 m3; parque industrial del norte; reynosa,tamps. 88736 ; MX 88736
• Manufacturer Contact: courtney smith ; aaholmvej 1 - 3; osted; lejre 4320 ; DA 4320 ; 6032470255
• MDR Report Key: 25481980
• Report Number: 3003442380-2026-31569
• Device Sequence Number: 9965647
• Product Code: FPA
• UDI-Device Identifier: 05705244007833
• UDI-Public: 05705244007833
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: K160648
• 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): 05/20/2026

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-975
• Device Lot Number: UNKNOWN
• 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: 05/20/2026
• Initial Report FDA Received Date: 06/12/2026
• 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
• Outcome Attributed to Adverse Event: Death
• Patient Sex: Unknown