MAUDE Adverse Event Report: ANIMAS LLC ANIMAS VIBE; INSULIN INFUSION PUMP

Medical Device Problem Codes	Moisture Damage (1405); Temperature Problem (3022)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The pump has not been returned to animas for evaluation.If the device is returned, an evaluation shall be completed and a supplemental report will be filed.No conclusions can be made at this time.
Event or Problem Description
On (b)(6) 2018, the reporter contacted animas, alleging a temperature (temp ¿ moisture ingress) issue.The reporter alleged the pump was hot and contained moisture after swimming in a hot tub.There was no indication that the product caused or contributed to an adverse event.This complaint is being reported because there is the potential for the user to experience an injury to the skin due to increased pump temperature.
Additional Manufacturer Narrative
Device evaluation: the device has been returned and evaluated by product analysis on 02-aug-2018 with the following findings: review of the black box data revealed evidence of sudden drop in voltage resulting from a low battery warning and a replace battery alarm on (b)(4) 2018.There was no evidence of moisture inside the battery compartment.On investigation, the pump powered on normally with the returned battery cap properly in place on the pump.The pump was exercised for 24 hours without any errors, alarms, warnings, overheating or interruption in power.The electrical currents were evaluated and found to be outside of specifications due to excessive moisture contamination in the pump¿s interior component.Leak testing revealed a leak through the display lens.Unrelated to the original complaint, the battery compartment was noted to be cracked during the investigation.

• Brand Name: ANIMAS VIBE
• Common Device Name: INSULIN INFUSION PUMP
• Manufacturer (Section D): ANIMAS LLC; 200 lawrence dr; west chester PA 19380 3428
• MDR Report Key: 7667123
• Report Number: 2531779-2018-12418
• Device Sequence Number: 1040380
• Product Code: OYC
• UDI-Device Identifier: 10840406100228
• UDI-Public: 10840406100228
• Combination Product (Y/N): Y
• Initial Reporter State: TX
• Initial Reporter Country: US
• PMA/510(K) Number: P130007
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 06/23/2018

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
• Operator of Device: Lay User/Patient
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/30/2018
• Was the Report Sent to FDA?: Yes
• Device Age: 23 MO
• Initial Date Received by Manufacturer: 06/23/2018
• Supplement Date Received by Manufacturer: 06/23/2018
• Initial Report FDA Received Date: 07/06/2018
• Supplement Report FDA Received Date: 08/20/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 31 YR
• Patient Weight: 177