BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM REAL-TIME INSULIN INFUSION PUMP

    MDR report key: 2112348 · Received May 26, 2011

    Report

    Report Number
    3004209178-2011-81598
    Event Type
    Injury
    Date Received
    May 26, 2011
    Date of Event
    April 5, 2011
    Report Date
    May 16, 2011
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS MED-REL
    Product Code
    MDS
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CT, 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. THE DEVICE HAS BEEN RETURNED, BUT NOT YET EVALUATED. NO CONCLUSION CAN BE DRAWN AT THIS TIME. FURTHER INFORMATION WILL FOLLOW ONCE THE ANALYSIS HAS BEEN COMPLETED.

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED THAT HE WAS HOSPITALIZED FOR HYPOGLYCEMIA, WITH BLOOD GLUCOSE OF 22 MG/DL. THE CUSTOMER STATED THAT PARAMEDICS ALSO CAME TO HIS HOUSE AND TREATED HIM. THE CUSTOMER ALSO STATED THAT HE USES A QUICK-SET INFUSION SET AND THAT HE CHANGES HIS INFUSION SET EVERY TWO TO THREE DAYS. 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 MED-REL MMT-722NAS

    Patients

    Seq Age Sex Outcome Treatment
    1 51 YR Hospitalization UNOMEDICAL QUICK-SET INSULIN INFUSION SET,| MODEL MMT-397