Brand Name | T:SLIM INSULIN DELIVERY SYSTEM |
Type of Device | INSULIN PUMP |
Manufacturer (Section D) |
TANDEM DIABETES CARE |
11075 roselle street |
san diego CA 92121 |
|
Manufacturer Contact |
julia
kensick
|
11075 roselle st. |
san diego, CA 92121
|
8583666900
|
|
MDR Report Key | 8812797 |
MDR Text Key | 151762564 |
Report Number | 3013756811-2019-43397 |
Device Sequence Number | 1 |
Product Code |
LZG
|
UDI-Device Identifier | 00852162004361 |
UDI-Public | 00852162004361 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K111210 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
consumer |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
07/22/2019 |
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
|
Device Operator |
Lay User/Patient
|
Device Model Number | 004628 |
Device Catalogue Number | 007435 |
Was Device Available for Evaluation? |
No
|
Was the Report Sent to FDA? |
Yes
|
Initial Date Manufacturer Received |
07/01/2019 |
Initial Date FDA Received | 07/22/2019 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 10/01/2015 |
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Reuse
|
Patient Sequence Number | 1 |
Treatment | INFUSION SET: AUTOSOFT 90, INSULIN: HUMALOG |
Patient Outcome(s) |
Hospitalization;
Life Threatening;
Required Intervention;
|
Patient Age | 73 YR |