BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PUMP MMT-512WWB PRDGM INSULIN BL EN

    MDR report key: 1811192 · Received August 9, 2010

    Report

    Report Number
    2032227-2010-82192
    Event Type
    Malfunction
    Date Received
    August 9, 2010
    Date of Event
    July 30, 2010
    Report Date
    August 4, 2010
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    LZG
    PMA / PMN Number
    K030531
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FR
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    CURRENTLY, IT IS UNK 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 INFO WILL FOLLOW ONCE THE ANALYSIS HAS BEEN COMPLETED. NO CONCLUSION CAN BE DRAWN AT THIS TIME.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE NO DELIVERY ALARM WAS NOT FUNCTIONING. NOTHING FURTHER WAS REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PUMP MMT-512WWB PRDGM INSULIN BL EN INFUSION PUMP LZG MEDTRONIC MINIMED MMT-512WWB

    Patients

    Seq Age Sex Outcome Treatment
    1