BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM REAL-TIME INSULIN INFUSION PUMP

    MDR report key: 2033807 · Received March 17, 2011

    Report

    Report Number
    3004209178-2011-80692
    Event Type
    Injury
    Date Received
    March 17, 2011
    Date of Event
    February 13, 2011
    Report Date
    March 3, 2011
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS CO., MED REL
    Product Code
    MDS
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, 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. THE DEVICE HAS BEEN RETURNED, BUT NOT YET EVALUATED. NO CONCLUSION CAN BE DRAWN AT THIS TIME. FURTHER INFO WILL FOLLOW ONCE THE ANALYSIS HAS BEEN COMPLETED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE CUSTOMER WAS HOSPITALIZED DUE TO DIABETIC KETOACIDOSIS, WITH A BLOOD GLUCOSE READING OF 800 MG/DL. THE CUSTOMER'S MOTHER STATED THAT RECENTLY, THE CUSTOMER HAD BEEN EXPERIENCING HIGH BLOOD GLUCOSE LEVELS DUE TO A BUTTON ISSUE. THE CUSTOMER'S MOTHER ALSO STATED THAT THERE HAS BEEN MOISTURE UNDER THE INSULIN PUMP DISPLAY SCREEN FOR A YEAR. 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 PUERTO RICO OPERATIONS CO., MED REL MMT-522NAS

    Patients

    Seq Age Sex Outcome Treatment
    1 9 YR Hospitalization