BEUDAMED
    FDA Adverse Event Injury Summary report: N

    INPEN MMT-105NNGYNA NOVO NORDISK GRAY

    MDR report key: 11872110 · Received May 24, 2021

    Report

    Report Number
    3012822846-2021-00186
    Event Type
    Injury
    Date Received
    May 24, 2021
    Date of Event
    September 28, 2020
    Report Date
    May 24, 2021
    Manufacturer
    COMPANION MEDICAL INC
    Product Code
    FMF
    UDI-DI
    000010862088000351
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, 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. THIS MDR IS RELATED TO THE RETROSPECTIVE REVIEW OF COMPLAINTS FROM COMPANION MEDICAL INC, FOLLOWING MEDTRONICS ACQUISITION OF THE COMPANY IN (B)(6) 2020

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED VIA PHONE CALL THAT THE INSULIN PEN IS NO LONGER DELIVERING INSULIN. CUSTOMER STATED THE SCREW DOES NOT MOVE. THE CUSTOMER ALSO REPORTED THAT THEY EXPERIENCED HIGH BLOOD GLUCOSE. THE BLOOD GLUCOSE READING WAS 400 MG/DL. THE CUSTOMER TREATED THEIR HIGH BLOOD GLUCOSE WITH MANUAL INJECTION. NO HARM REQUIRING MEDICAL INTERVENTION WAS REPORTED. THE INSULIN PEN WILL NOT BE RETURNED FOR ANALYSIS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    768620 INPEN MMT-105NNGYNA NOVO NORDISK GRAY SYRINGE, PISTON FMF COMPANION MEDICAL INC MMT-105NNGYNA B93BY 000010862088000351

    Patients

    Seq Age Sex Outcome Treatment
    1