BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM REAL-TIME INSULIN INFUSION PUMP

    MDR report key: 1981038 · Received February 2, 2011

    Report

    Report Number
    3004209178-2011-80305
    Event Type
    Injury
    Date Received
    February 2, 2011
    Date of Event
    January 18, 2011
    Report Date
    January 24, 2011
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS MED-REL
    Product Code
    MDS
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MS, 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. THE DEVICE WILL BE RETURNED FOR ANALYSIS AND FURTHER INFO WILL FOLLOW ONCE THE ANALYSIS HAS BEEN COMPLETED.

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED BEING ADMITTED IN THE INTENSIVE CARE UNIT FOR DIABETES KETOACIDOSIS AND HIGH BLOOD GLUCOSE OF 900 MG/DL. THE CUSTOMER STATED THAT THE DOCTOR MENTIONED THE CANNULA WAS BENT OUTSIDE HIS BODY AND 100 UNITS OF INSULIN WERE GONE, BUT THE TAPE DID NOT APPEAR TO BE WET. THE CUSTOMER STATED THAT HE IS STILL ON BACK UP PLAN AND THE DOCTOR REQUESTED TO HAVE A REPLACEMENT OF THE INSULIN PUMP. NO FURTHER INFO WAS PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PARADIGM REAL-TIME INSULIN INFUSION PUMP INSULIN INFUSION PUMP MDS MEDTRONIC PUERTO RICO OPERATIONS MED-REL MMT-722NAL

    Patients

    Seq Age Sex Outcome Treatment
    1 49 YR Hospitalization