BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM REAL-TIME INSULIN INFUSION PUMP

    MDR report key: 2033995 · Received March 18, 2011

    Report

    Report Number
    2032227-2011-00706
    Event Type
    Injury
    Date Received
    March 18, 2011
    Date of Event
    March 6, 2011
    Report Date
    March 6, 2011
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    MDS
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    NURSE

    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. WE, THEREFORE, CONSIDER THIS REPORT COMPLETE TO THE BEST OF OUR KNOWLEDGE.

    Description of Event or Problem · 1

    THE CUSTOMER WAS HOSPITALIZED FOR A HIGH BLOOD GLUCOSE LEVEL OF 659 MG/DL. PRIOR TO THE EVENT, THE CUSTOMER'S INFUSION SET HAD DISLODGED, AND THE CUSTOMER DIDN'T HAVE ANOTHER ONE TO REPLACE IT. UNABLE TO TROUBLESHOOT AS THE CUSTOMER WAS OUT OF TOWN, AND HAD NO SUPPLIES WITH HER. ADVISED THAT THE LOCAL REP. WOULD BE CONTACTED. 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-722LNAP

    Patients

    Seq Age Sex Outcome Treatment
    1 31 YR Hospitalization