BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MINIMED 770G OUS SYSTEM BLE CONNECT 3.0 MMOL/L

    MDR report key: 12577103 · Received October 5, 2021

    Report

    Report Number
    2032227-2021-201461
    Event Type
    Injury
    Date Received
    October 5, 2021
    Date of Event
    October 3, 2021
    Report Date
    October 5, 2021
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS CO.
    Product Code
    OZP
    UDI-DI
    000000763000418151
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AS
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). 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 REPORTED VIA PHONE CALL THAT THEY EXPERIENCED HIGH BLOOD GLUCOSE. BLOOD GLUCOSE READING WAS 25 MMOL/L AT TIME OF INCIDENT. CUSTOMER CURRENT BLOOD GLUCOSE WAS 25 MMOL/L. CUSTOMER DECLINED TO TROUBLESHOOT FOR HIGH BLOOD GLUCOSE. AUTO MODE FEATURE WAS NOT ACTIVE AT TIME OF EVENT. THE PUMP WILL NOT BE RETURNED FOR ANALYSIS. FRN-UNK-RSVR, UNOMED INF FRN-SET.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1475188 MINIMED 770G OUS SYSTEM BLE CONNECT 3.0 MMOL/L ARTIFICIAL PANCREAS DEVICE SYSTEM, SINGLE HORMONAL CONTROL OZP MEDTRONIC PUERTO RICO OPERATIONS CO. MMT-1881 HG5GYLPZZ 000000763000418151

    Patients

    Seq Age Sex Outcome Treatment
    1