FDA Adverse Event Injury Summary report: N

PUMP MMT-712LNAP PRDGM INS PL EN US LN

MDR report key: 1231878 · Received November 12, 2008

Report

Report Number
2032227-2008-01944
Event Type
Injury
Date Received
November 12, 2008
Date of Event
October 25, 2008
Report Date
November 1, 2008
Manufacturer
MEDTRONIC MINIMED
Product Code
LZG
PMA / PMN Number
K031390
Adverse Event
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. 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 DUE TO DIABETIC KETOACIDOSIS. THE CUSTOMER STATED THAT THE ELEVATED BLOOD GLUCOSE LEVELS WERE CAUSED BY THE FLU AND WEARING THE INFUSION SET FOR THREE DAYS. NOTHING FURTHER WAS REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 PUMP MMT-712LNAP PRDGM INS PL EN US LN INFUSION PUMP LZG MEDTRONIC MINIMED MMT-712LNAP

Patients

Seq Age Sex Outcome Treatment
1 Hospitalization