BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM INSULIN INFUSION PUMP

    MDR report key: 2101564 · Received May 20, 2011

    Report

    Report Number
    3004209178-2011-81547
    Event Type
    Injury
    Date Received
    May 20, 2011
    Date of Event
    May 13, 2011
    Report Date
    May 13, 2011
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS MED-REL
    Product Code
    MDS
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    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

    IT WAS REPORTED THAT THE CUSTOMER WAS HOSPITALIZED IN A (B)(6) WARD. THE CUSTOMER'S FRIEND STATED THAT THE CUSTOMER WAS NOT RECEIVING INSULIN AND HAD BEEN TAKING OFF THE INSULIN PUMP. THE NURSE ON DUTY STATED THAT THERE WAS A DIABETES SPECIALIST MONITORING THE CUSTOMER'S INSULIN NEEDS. THE NURSE LATER STATED THAT THE CUSTOMER HAD A HIGH BLOOD GLUCOSE LEVEL OF 263 MG/DL THAT THEY TREATED WITH A DOSE OF LANTUS. THE NURSE ALSO STATED THAT THE CUSTOMER WAS POSSIBLY MENTALLY DISTURBED. NOTHING FURTHER WAS REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PARADIGM INSULIN INFUSION PUMP INSULIN INFUSION PUMP MDS MEDTRONIC PUERTO RICO OPERATIONS MED-REL MMT-523NAL

    Patients

    Seq Age Sex Outcome Treatment
    1 60 YR Hospitalization