FDA Adverse Event Injury Summary report: N

PUMP MMT-512LNAP PRDGM INS PL EN US LN

MDR report key: 1033881 · Received April 24, 2008

Report

Report Number
2032227-2008-00708
Event Type
Injury
Date Received
April 24, 2008
Date of Event
April 11, 2008
Report Date
April 12, 2008
Manufacturer
MEDTRONIC MINIMED
Product Code
LZG
PMA / PMN Number
K030531
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
AZ, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

CURRENTLY, IT IS UNK WHETHER OR NOT THE DEVICE MAY HAVE CAUSED OR CONTRIBUTED TO THE EVENT AS NO PRODUCT HAS BEEN RETURNED. WE THEREFORE CONSIDER THIS REPORT COMPLETE TO THE BEST OF OUR KNOWLEDGE. NO CONCLUSION CAN BE DRAWN AT THIS TIME.

Description of Event or Problem · 1

THE CUSTOMER STATED THAT SHE WAS HOSPITALIZED FOR DIABETIC KETOACIDOSIS WITH NAUSEA, VOMITING AND DEHYDRATION. NO BLOOD GLUCOSE READING WAS REPORTED. THE CUSTOMER ALSO STATED THAT SHE HAD A KIDNEY AND VAGINAL INFECTION, WHICH SHE WAS TAKING ANTI-BIOTICS FOR. TROUBLESHOOTING WAS PERFORMED AND THE INSULIN PUMP WAS PROGRAMMED CORRECTLY. THE INSULIN PUMP PASSED THE PRIME AND HIGH PRESSURE TESTS. NOTHING FURTHER WAS REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 PUMP MMT-512LNAP PRDGM INS PL EN US LN INFUSION PUMP LZG MEDTRONIC MINIMED MMT-512LNAP

Patients

Seq Age Sex Outcome Treatment
1 Hospitalization