BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PUMP MMT-722WWS PRDGM INSULIN SK EN ML

    MDR report key: 1900061 · Received November 8, 2010

    Report

    Report Number
    3004209178-2010-83277
    Event Type
    Malfunction
    Date Received
    November 8, 2010
    Date of Event
    October 27, 2010
    Report Date
    November 2, 2010
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS MED-REL
    Product Code
    MDS
    PMA / PMN Number
    P980022
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SZ
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THE INSULIN PUMP WAS RECEIVED WITH A FROZEN SCREEN AFTER COUNT UP DUE TO A PROBLEM WITH THE LIQUID CRYSTAL DISPLAY BOARD. UNABLE TO PERFORM FURTHER TESTING DUE TO THE FROZEN SCREEN.

    Description of Event or Problem · 1

    THE INSULIN PUMP WAS RETURNED FOR AN UNKNOWN REASON.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PUMP MMT-722WWS PRDGM INSULIN SK EN ML INFUSION PUMP MDS MEDTRONIC PUERTO RICO OPERATIONS MED-REL MMT-722WWS

    Patients

    Seq Age Sex Outcome Treatment
    1