BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PARADIGM REAL-TIME INSULIN INFUSION PUMP

    MDR report key: 1991599 · Received January 28, 2011

    Report

    Report Number
    2032227-2011-00294
    Event Type
    Malfunction
    Date Received
    January 28, 2011
    Date of Event
    January 6, 2010
    Report Date
    January 24, 2011
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    MDS
    PMA / PMN Number
    P980022
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THE INSULIN PUMP HAD A FROZEN DISPLAY DUE TO A FAULTY COMPONENT ON THE INTERFACE BOARD. NO BLANK DISPLAY OR CONSTANT TONE WAS NOTED.

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED A BLANK DISPLAY AND CONSTANT TONE AFTER DROPPING THE INSULIN PUMP ON A TILE FLOOR. TROUBLESHOOTING WAS PERFORMED, BUT THE ISSUES WERE NOT RESOLVED. ADVISED THAT THE INSULIN PUMP WOULD BE REPLACED. NOTHING FURTHER WAS REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PARADIGM REAL-TIME INSULIN INFUSION PUMP INSULIN INFUSION PUMP MDS MEDTRONIC MINIMED MMT-722LNAS

    Patients

    Seq Age Sex Outcome Treatment
    1 15 YR