BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PUMP MMT-522NAS PRDGM INS V2.2 SK EN

    MDR report key: 1060265 · Received June 11, 2008

    Report

    Report Number
    3004209178-2008-00409
    Event Type
    Injury
    Date Received
    June 11, 2008
    Date of Event
    May 21, 2008
    Report Date
    May 30, 2008
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS MED-REL
    Product Code
    LZG
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

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

    Description of Event or Problem · 1

    THE CUSTOMER STATED THAT SHE WAS HOSPITALIZED FOR LOW BLOOD GLUCOSE LEVELS. THE CUSTOMER STATED THAT SHE LOST CONSCIOUSNESS, HAD A HEART ATTACK AND LOW BLOOD PRESSURE. NO BLOOD GLUCOSE READING WAS REPORTED FOR THE EVENT. THE CUSTOMER STATED THAT SHE HAS NOT BEEN ON THE INSULIN PUMP SINCE THE EVENT AND WILL CONTINUE WITH MANUAL INJECTIONS UNTIL SHE SEES HER ENDOCRINOLOGIST. NOTHING FURTHER WAS REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PUMP MMT-522NAS PRDGM INS V2.2 SK EN INFUSION PUMP LZG MEDTRONIC PUERTO RICO OPERATIONS MED-REL MMT-522NAS

    Patients

    Seq Age Sex Outcome Treatment
    1 51 YR Hospitalization