BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM REAL-TIME INSULIN INFUSION PUMP

    MDR report key: 2031016 · Received March 16, 2011

    Report

    Report Number
    2032227-2011-00666
    Event Type
    Injury
    Date Received
    March 16, 2011
    Date of Event
    February 19, 2011
    Report Date
    February 24, 2011
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    MDS
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    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

    IT WAS REPORTED THAT THE CUSTOMER WAS HOSPITALIZED FOR DIABETIC KETOACIDOSIS, WITH A BLOOD GLUCOSE READING OF 374 MG/DL. PRIOR TO THE EVENT, THE CUSTOMER WOKE UP WITH A BLOOD GLUCOSE READING OF 348 MG/DL. THE CUSTOMER CHANGED THE INFUSION SET, BUT THE BLOOD GLUCOSE LEVELS REMAINED ELEVATED. TROUBLESHOOTING WAS PERFORMED, AND THE INSULIN PUMP ALARMED. NO DELIVERY DURING THE PRIME. FOUND THAT THE TUBING WAS NOT CONNECTED TO THE RESERVOIR PROPERLY. AFTER CHANGING THE INFUSION SET, THE INSULIN PUMP PASSED THE PRIME TEST. 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-722RNAS

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR Hospitalization