BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    670G INSULIN PUMP MMT-1780KL

    MDR report key: 12208588 · Received July 22, 2021

    Report

    Report Number
    2032227-2021-170837
    Event Type
    Malfunction
    Date Received
    July 22, 2021
    Date of Event
    July 13, 2021
    Report Date
    November 3, 2021
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS CO.
    Product Code
    OZP
    UDI-DI
    000000763000365882
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NV, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 0

    ON (B)(6) 2021 THE CUSTOMER ALLEGED THE DEVICE ALARM CRITICAL PUMP ERROR 35. DEVICE RECEIVED WITH CRITICAL PUMP ERROR (OPEN BOOK) AND CREST DOWNLOAD UNSUCCESSFUL DUE TO MOISTURE DAMAGE ON ELECTRONICS ASSEMBLY STACK ELECTRICAL BOARD 1 AND ELECTRICAL BOARD 2. UNABLE TO PERFORMED DISPLACEMENT TEST, REWIND TEST, PRIME/SEATING TEST, BASIC OCCLUSION TEST, FORCE SENSOR TEST, OCCLUSION TEST, SLEEP CURRENT MEASUREMENT, ACTIVE CURRENT MEASUREMENT AND SELF TEST DUE TO CRITICAL PUMP ERROR. DEVICE RECEIVED WITH MOISTURE DAMAGE NOTED ON, 40 PIN FLEXIBLE PRINTED CIRCUIT/LCD, ELECTRONICS STACK ELECTRICAL BOARD 1, ELECTRICAL BOARD 2, MOTOR AND BATTERY TUBE. HOWEVER, DEVICE TESTED WITH REFERENCE TEST ELECTRONICS STACK ELECTRICAL BOARD 1 AND ELECTRICAL BOARD 2, WAS ABLE TO BOOT UP PROPERLY WITH NO UNEXPECTED CRITICAL PUMP ERROR ALARM NOTED. UNABLE TO VERIFY PUMP ERROR 35 DUE TO DOWNLOAD DIFFICULTIES. DEVICE RECEIVED WITH CRACKED BATTERY TUBE THREADS AND CRACKED CASE CORNER OF BELT CLIP RAILS. THE DEVICE P-CAP / TEST RESERVOIR LOCKS IN PLACE PROPERLY. IN SUMMARY, CUSTOMER ALLEGATION FOR CRITICAL PUMP ERROR ALARM WAS CONFIRMED, HOWEVER, DEVICE TESTED WITH REFERENCE TEST ELECTRONICS STACK ELECTRICAL BOARD 1 AND ELECTRICAL BOARD 2, WAS ABLE TO BOOT UP PROPERLY WITH NO UNEXPECTED CRITICAL PUMP ERROR ALARM NOTED. MEDTRONIC, INC. (MEDTRONIC) IS SUBMITTING THIS REPORT TO COMPLY WITH 21 C.F.R. PART 803, THE MEDICAL DEVICE REPORTING REGULATION. THIS REPORT IS BASED UPON INFORMATION OBTAINED BY MEDTRONIC, WHICH THE COMPANY MAY NOT HAVE BEEN ABLE TO FULLY INVESTIGATE OR VERIFY PRIOR TO THE DATE THE REPORT WAS REQUIRED BY THE FDA. MEDTRONIC HAS MADE REASONABLE EFFORTS TO OBTAIN MORE COMPLETE INFORMATION IN THE TIME ALLOTTED AND HAS PROVIDED AS MUCH INFORMATION AS IS AVAILABLE TO THE COMPANY AS OF THE SUBMISSION DATE THIS REPORT. THIS REPORT DOES NOT CONSTITUTE AN ADMISSION OR A CONCLUSION BY FDA, MEDTRONIC, OR ITS EMPLOYEES THAT THE DEVICE, MEDTRONIC, OR ITS EMPLOYEES CAUSED OR CONTRIBUTED TO THE EVENT DESCRIBED IN THE REPORT. IN PARTICULAR, THIS REPORT DOES NOT CONSTITUTE AN ADMISSION BY ANYONE THAT THE PRODUCT DESCRIBED IN THIS REPORT HAS ANY "DEFECTS" OR HAS "MALFUNCTIONED". THESE WORDS ARE INCLUDED IN THE FDA 3500A FORM AND ARE FIXED ITEMS FOR SELECTION CREATED BY THE FDA, TO CATEGORIZE THE TYPE OF EVENT SOLELY FOR THE PURPOSE OF REPORTING PURSUANT TO PART 803. MEDTRONIC OBJECTS TO THE USE OF THESE WORDS AND OTHERS LIKE IT BECAUSE OF THE LACK OF DEFINITION AND THE CONNOTATIONS IMPLIED BY THESE TERMS. THIS STATEMENT SHOULD BE INCLUDED WITH ANY INFORMATION OR REPORT DISCLOSED TO THE PUBLIC UNDER THE FREEDOM OF INFORMATION ACT.

    Additional Manufacturer Narrative · 1

    (B)(4). CURRENTLY IT IS UNKNOWN WHETHER OR NOT THE DEVICE MAY HAVE CAUSED OR CONTRIBUTED TO THE EVENT. THE DEVICE HAS BEEN RETURNED, BUT NOT YET EVALUATED. FURTHER INFORMATION WILL FOLLOW ONCE THE ANALYSIS HAS BEEN COMPLETED. NO CONCLUSION CAN BE DRAWN AT THIS TIME.

    Description of Event or Problem · 1

    INFORMATION RECEIVED BY MEDTRONIC INDICATED THAT THE INSULIN PUMP HAD CRACK AND A BROKEN FORCE SENSOR WAS DETECTED DURING SEATING OR REGULAR DELIVERY ERROR. NO HARM REQUIRING MEDICAL INTERVENTION WAS REPORTED. THE DEVICE WILL BE RETURNED FOR ANALYSIS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1110880 670G INSULIN PUMP MMT-1780KL ARTIFICIAL PANCREAS DEVICE SYSTEM, SINGLE HORMONAL CONTROL OZP MEDTRONIC PUERTO RICO OPERATIONS CO. MMT-1780KL HG4KKZB 000000763000365882

    Patients

    Seq Age Sex Outcome Treatment
    1 14 YR