BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PUMP MMT-1782KL 670G MM RPL

    MDR report key: 17359235 · Received July 20, 2023

    Report

    Report Number
    2032227-2023-239442
    Event Type
    Malfunction
    Date Received
    July 20, 2023
    Date of Event
    June 30, 2023
    Report Date
    November 14, 2023
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS CO.
    Product Code
    OZP
    UDI-DI
    000000763000283599
    PMA / PMN Number
    P160017
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    003

    Narratives

    Additional Manufacturer Narrative · 0

    THE PUMP PASSED THE SELF TEST, REWIND TEST, PRIME/SEATING TEST, BASIC OCCLUSION TEST, OCCLUSION TEST, FORCE SENSOR TEST, AND DISPLACEMENT TEST. THE INSULIN FLOW BLOCKED ALARM FUNCTIONED PROPERLY DURING THE BASIC OCCLUSION, OCCLUSION, AND FORCE SENSOR TESTS. NO UNEXPECTED INSULIN FLOW BLOCKED ALARMS WERE NOTED DURING TESTING. SUCCESSFULLY DOWNLOADED THE TRACE AND HISTORY FILES USING THUS. A REVIEW OF THE PUMP HISTORY FILE REVEALS THE FOLLOWING NO DELIVERY (INSULIN FLOW BLOCKED) ALARMS FOR (B)(6) 2023 THROUGH (B)(6) 2023 (EVENT DATE AND TWO DAYS PRIOR): (B)(6) 2023 20:19:11 ALARMALERTNOTIFICATION (40) FAULTNUMBER: NODELIVERY (7) DURING A CL1 FOOD BOLUS DELIVERY. (B)(6) 2023 20:20:05 ALARMALERTNOTIFICATION (40) FAULTNUMBER: NODELIVERY (7) DURING A TUBING FILL DELIVERY. (B)(6) 2023 09:27:44 ALARMALERTNOTIFICATION (40) FAULTNUMBER: NODELIVERY (7) DURING A CL1 FOOD BOLUS DELIVERY. (B)(6) 2023 09:28:38 ALARMALERTNOTIFICATION (40) FAULTNUMBER: NODELIVERY (7) DURING A TUBING FILL DELIVERY. (B)(6) 2023 10:07:03 ALARMALERTNOTIFICATION (40) FAULTNUMBER: NODELIVERY (7) DURING A BOLUS WIZARD DELIVERY. (B)(6) 2023 10:08:05 ALARMALERTNOTIFICATION (40) FAULTNUMBER: NODELIVERY (7) DURING A TUBING FILL DELIVERY. (B)(6) 2023 10:08:51 ALARMALERTNOTIFICATION (40) FAULTNUMBER: NODELIVERY (7) DURING A TUBING FILL DELIVERY. (B)(6) 2023 10:57:27 ALARMALERTNOTIFICATION (40) FAULTNUMBER: NODELIVERY (7) DURING A BOLUS WIZARD DELIVERY. (B)(6) 2023 11:07:02 ALARMALERTNOTIFICATION (40) FAULTNUMBER: NODELIVERY (7) DURING A BOLUS WIZARD DELIVERY. (B)(6) 2023 11:23:09 ALARMALERTNOTIFICATION (40) FAULTNUMBER: NODELIVERY (7) DURING A BOLUS WIZARD DELIVERY. (B)(6) 2023 11:24:27 ALARMALERTNOTIFICATION (40) FAULTNUMBER: NODELIVERY (7) DURING A TUBING FILL DELIVERY. (B)(6) 2023 12:45:54 ALARMALERTNOTIFICATION (40) FAULTNUMBER: NODELIVERY (7) DURING A TUBING FILL DELIVERY. (B)(6) 2023 12:46:46 ALARMALERTNOTIFICATION (40) FAULTNUMBER: NODELIVERY (7) DURING A TUBING FILL DELIVERY. THE PUMP WAS CUT OPEN FOR VISUAL INSPECTION. NO EVIDENCE OF PHYSICAL OR MOISTURE DAMAGE WAS FOUND ON THE ELECTRONIC ASSEMBLY (PCBA 1 AND PCBA 2), MOTOR, OR FORCE SENSOR. A TEST P-CAP DOES LOCK INTO PLACE INSIDE THE RESERVOIR COMPARTMENT PROPERLY. THE FOLLOWING WERE NOTED DURING THE PHYSICAL INSPECTION: SCRATCHED CASE AND PILLOWING KEYPAD OVERLAY. INSULIN FLOW BLOCKED ALARM COMPLAINT IS NOT CONFIRMED. NO UNEXPECTED INSULIN FLOW BLOCKED ALARM NOTED DURING TESTING. 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 · 0

    THIS MDR RELATED TO THE PUERTO RICO MANUFACTURING SITE HAS BEEN ASSIGNED A MEDWATCH NUMBER FROM THE MEDTRONIC MINIMED NORTHRIDGE SITE, PER VARIANCE 5. CURRENTLY IT IS UNKNOWN WHETHER OR NOT THE DEVICE MAY HAVE CAUSED OR CONTRIBUTED TO THE EVENT AS NO PRODUCT HAS BEEN RETURNED. THE DEVICE WILL BE RETURNED FOR ANALYSIS AND FURTHER INFORMATION WILL FOLLOW ONCE THE ANALYSIS HAS BEEN COMPLETED. NO CONCLUSION CAN BE DRAWN AT THIS TIME. SELECT PATIENT INFORMATION CANNOT BE PROVIDED DUE TO REGIONAL PRIVACY REGULATIONS. 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.

    Description of Event or Problem · 0

    INFORMATION RECEIVED BY MEDTRONIC INDICATED THAT THE CUSTOMER REPORTED RECURRING INSULIN FLOW BLOCK. TROUBLESHOOTING WAS PERFORMED AND FOUND THAT THE CUSTOMER CHANGED THE SET EVERY 2-3 DAYS. NOT TRIED DIFFERENT CANNULA LENGTHS. CUSTOMER HAD THE BOLUS DELIVERY ON FAST, EVEN AFTER TURNED IT BACK TO STANDARD PUMP STILL ALARMS INSULIN FLOW BLOCK. NO HARM REQUIRING MEDICAL INTERVENTION WAS REPORTED. THE CUSTOMER WILL DISCONTINUE USING THE INSULIN PUMP. THE INSULIN PUMP WILL BE RETURNED FOR ANALYSIS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    840484 PUMP MMT-1782KL 670G MM RPL AUTOMATED INSULIN DOSING DEVICE SYSTEM, SINGLE HORMONAL CONTROL OZP MEDTRONIC PUERTO RICO OPERATIONS CO. MMT-1782KL HG62EE1 000000763000283599

    Patients

    Seq Age Sex Outcome Treatment
    1 18 YR Unknown