BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM REAL-TIME INSULIN INFUSION PUMP

    MDR report key: 2002560 · Received February 16, 2011

    Report

    Report Number
    3004209178-2011-80441
    Event Type
    Injury
    Date Received
    February 16, 2011
    Date of Event
    February 5, 2011
    Report Date
    February 6, 2011
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS MED-REL
    Product Code
    MDS
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    CURRENTLY, IT IS UNKNOWN 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 INFORMATION WILL FOLLOW ONCE THE ANALYSIS HAS BEEN COMPLETED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE CUSTOMER WENT TO A HOSPITAL FOR LOW BLOOD GLUCOSE THE NIGHT BEFORE. IT WAS STATED THAT A CUSTOMER'S FRIEND BROUGHT HIM A SODA AND HE WAS BACK ABOVE TARGET AND LEFT THE HOSPITAL. IT WAS STATED THAT THE MOTHER HAD CALLED EARLIER TO REPORT THE BUTTONS ON THE DEVICE WERE NOT FUNCTIONING. TROUBLESHOOTING WAS DECLINED AS BUTTONS WERE UNRESPONSIVE, BUT THE TIME WAS MOVING FORWARD. NO FURTHER INFORMATION 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 19 YR Hospitalization