BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    RSVR MMT-326A 10PK PRDGM 1.8ML 13L

    MDR report key: 1070387 · Received June 30, 2008

    Report

    Report Number
    2032227-2008-01093
    Event Type
    Malfunction
    Date Received
    June 30, 2008
    Date of Event
    June 12, 2008
    Report Date
    June 12, 2006
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    FMF
    PMA / PMN Number
    K001828
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    NOT APPLICABLE

    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. THE DEVICE WILL BE RETURNED FOR ANALYSIS AND FURTHER INFORMATION WILL FOLLOW ONCE THE ANALYSIS HAS BEEN COMPLETED.

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED THAT BEING HOSPITALIZED FOR DIABETES KETOACIDOSIS. THE BLOOD GLUCOSE READING WAS 503MG/DL. THE CUSTOMER STATED THAT SHE PERFORMED A FIXED PRIME TEST AND NO INSULIN CAME OUT. THE CUSTOMER STATED THAT SHE FOUND MOISTURE AT THE TUBING CONNECTION AND THE RESERVOIR. ALSO, THE CUSTOMER NOTICED A CRACK IN THE TUBING NEAR RESERVOIR CONNECTION. NO FURTHER INFORMATION WAS PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RSVR MMT-326A 10PK PRDGM 1.8ML 13L DISPOSABLES FMF MEDTRONIC MINIMED MMT-326A WK0707608

    Patients

    Seq Age Sex Outcome Treatment
    1