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

Medical Device Problem Codes	Structural Problem (2506); 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)2019, the reporter contacted animas, alleging a temperature (temp - physical damage) issue.The reporter alleged there was damage to the battery compartment and the pump got hot.The reporter denied moisture in the pump.There is no indication the alleged product issue 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 analysis: the device was returned, and investigation completed by product analysis on 15-apr-2019 with the following findings: there was no activity related to the complaint noted in the black box data or the pump¿s download history.No records of voltage drop appeared in the black box.On testing, the pump powered on normally and was exercised for 12 hours without overheating.The pump¿s electrical current draws were evaluated and found to be within specifications.The battery compartment was confirmed to be cracked.Inspection of the pump¿s interior compartment revealed an internal component was disconnected from the printed circuit board.There was no evidence of moisture inside the pump.

• Brand Name: ANIMAS VIBE
• Common Device Name: INSULIN INFUSION PUMP
• Manufacturer (Section D): ANIMAS LLC; 965 chesterbrook blvd; wayne PA 19087
• MDR Report Key: 8463755
• Report Number: 2531779-2019-02215
• Device Sequence Number: 10823066
• Product Code: OYC
• UDI-Device Identifier: 10840406103168
• UDI-Public: 10840406103168
• Combination Product (Y/N): Y
• Initial Reporter State: OK
• 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): 03/22/2019

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: 04/02/2019
• Was the Report Sent to FDA?: Yes
• Device Age: 20 MO
• Initial Date Received by Manufacturer: 03/22/2019
• Supplement Date Received by Manufacturer: 03/22/2019
• Initial Report FDA Received Date: 03/29/2019
• Supplement Report FDA Received Date: 04/16/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 56 YR