BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PUMP MMT-712LNAL PRDGM INS CL EN US LN

    MDR report key: 1252841 · Received December 4, 2008

    Report

    Report Number
    2032227-2008-02028
    Event Type
    Injury
    Date Received
    December 4, 2008
    Date of Event
    November 14, 2008
    Report Date
    November 14, 2008
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    LZG
    PMA / PMN Number
    K031390
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    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'S MOTHER REPORTED THAT THE CUSTOMER WAS HOSPITALIZED, DUE TO HYPERGLYCEMIA. THE REPORTED BLOOD GLUCOSE READING WAS 884 MG/DL. THE CUSTOMER'S MOTHER STATED THAT THE INSULIN PUMP ALARMED FAILED BATTERY TEST SEVERAL TIMES. NOTHING FURTHER WAS REPORTED.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 21 YR Hospitalization