BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM REAL-TIME INSULIN INFUSION PUMP

    MDR report key: 2041932 · Received March 29, 2011

    Report

    Report Number
    2032227-2011-00784
    Event Type
    Injury
    Date Received
    March 29, 2011
    Date of Event
    January 25, 2011
    Report Date
    March 15, 2011
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    MDS
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OK, 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. WE, THEREFORE, CONSIDER THIS REPORT COMPLETE TO THE BEST OF OUR KNOWLEDGE.

    Description of Event or Problem · 1

    THE CUSTOMER STATED THAT HE WAS HOSPITALIZED WITH A BLOOD GLUCOSE READING OF 22 MG/DL. PRIOR TO BEING HOSPITALIZED, THE CUSTOMER FELL OFF THE COUCH AND BROKE HIS HIP AFTER HE EXPERIENCED HYPOGLYCEMIA. NO TROUBLESHOOTING WAS PERFORMED AS THE INSULIN PUMP BEING WORN AT THE TIME OF THE EVENT, HAD ALREADY BEEN REPLACED. 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-522LNAS

    Patients

    Seq Age Sex Outcome Treatment
    1 49 YR Hospitalization