BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP

    MDR report key: 2040046 · Received March 25, 2011

    Report

    Report Number
    3004209178-2011-80810
    Event Type
    Malfunction
    Date Received
    March 25, 2011
    Date of Event
    March 14, 2011
    Report Date
    March 14, 2011
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS MED-REL
    Product Code
    MDS
    PMA / PMN Number
    P980022
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KS, 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 AS NO PRODUCT HAS BEEN RETURNED. NO CONCLUSION CAN BE DRAWN AT THIS TIME. THE DEVICE WILL BE RETURNED FOR ANALYSIS AND FURTHER INFO WILL FOLLOW ONCE THE ANALYSIS HAS BEEN COMPLETED.

    Description of Event or Problem · 1

    IT WAS REPORTED BY THE CUSTOMER THAT THE INSULIN PUMP WAS GIVING NO DELIVERY ALARMS. THE CUSTOMER STATED THAT SHE HAS CHANGED HER SET SEVERAL TIMES AND WAS STILL RECEIVING NO DELIVERY ALARMS. THE CUSTOMER ALSO STATED THAT WHEN SHE MANUALLY PRIMES, THE PISTON ONLY GOES UP SLIGHTLY. TROUBLESHOOTING WAS PERFORMED AND THE PISTON ANOMALY WAS CONFIRMED. THE INSULIN PUMP FAILED THE DISPLACEMENT TEST AND ALARMED MAX FILL INSTEAD OF NO RESERVOIR. NOTHING FURTHER WAS REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP INSULIN INFUSION PUMP MDS MEDTRONIC PUERTO RICO OPERATIONS MED-REL MMT-723NAH

    Patients

    Seq Age Sex Outcome Treatment
    1 30 YR