BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PUMP MMT-723LNAS PRDGM INS V2.3 SK EN LN

    MDR report key: 1853650 · Received September 29, 2010

    Report

    Report Number
    2032227-2010-82819
    Event Type
    Malfunction
    Date Received
    September 29, 2010
    Date of Event
    September 13, 2010
    Report Date
    September 13, 2010
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    MDS
    PMA / PMN Number
    P980022
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TN, US
    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. 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 A FROZEN SCREEN. ADVISED THE CUSTOMER TO REMOVE THE BATTERY FOR TWO HOURS AND CALL BACK IF THE ISSUE IS NOT RESOLVED. NOTHING FURTHER WAS REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PUMP MMT-723LNAS PRDGM INS V2.3 SK EN LN INFUSION PUMP MDS MEDTRONIC MINIMED MMT-723LNAS

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR