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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ANIMAS CORPORATION ANIMAS VIBE INSULIN INFUSION PUMP

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ANIMAS CORPORATION ANIMAS VIBE INSULIN INFUSION PUMP Back to Search Results
Device Problem Device Stops Intermittently (1599)
Patient Problem No Known Impact Or Consequence To Patient (2692)
Event Type  malfunction  
Manufacturer Narrative
The pump has been returned to animas. Evaluation has not yet been completed. When evaluation is complete a supplemental report will be filed. No conclusion can be made at this time.
 
Event Description
On (b)(6) 2016, the reporter contacted animas, alleging a power (intermittent power) issue. It was reported that there was an intermittent power issue. There was no indication that the product caused or contributed to an adverse event. This complaint is being reported because the user may be unaware that the pump has lost power, leading to under delivery.
 
Manufacturer Narrative
Follow-up #1: date of submission 10/4/2016. Device evaluation: the device has been returned and evaluated by product analysis on 09/07/2016 with the following findings: the black box shows multiple consecutive cs054/cs052/cs012 alarms. Pump powers on to blank display. Steps 6,7,10,11,13,21,22 failed due to blank display, unable to investigate intermittent power complaint. Opened pump, moisture damage found on printed circuit on eeprom, and display flex connector battery cap was not returned with pump. Bolus button cover is torn in center. Test battery cap was able to secure/detached properly.
 
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Brand NameANIMAS VIBE
Type of DeviceINSULIN INFUSION PUMP
Manufacturer (Section D)
ANIMAS CORPORATION
200 lawrence dr
west chester PA 19380 3428
Manufacturer (Section G)
ANIMAS CORPORATION
200 lawrence dr
west chester PA 19380 3428
Manufacturer Contact
karin sargrad
200 lawrence dr
west chester, PA 19380-3428
4843561808
MDR Report Key5849097
MDR Text Key52610010
Report Number2531779-2016-19087
Device Sequence Number1
Product Code MDS
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
P130007
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type consumer
Reporter Occupation Patient
Type of Report Initial,Followup
Report Date 07/16/2016
1 Device was Involved in the Event
0 Patients were Involved in the Event:
Date FDA Received08/04/2016
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator
Other Device ID Number011084040610005121277380316
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer10/02/2016
Is the Reporter a Health Professional? No
Was the Report Sent to FDA? Yes
Device Age13 MO
Event Location No Information
Date Manufacturer Received07/16/2016
Was Device Evaluated by Manufacturer? Yes
Date Device Manufactured06/02/2015
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Unkown

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