BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP

    MDR report key: 2133694 · Received June 9, 2011

    Report

    Report Number
    2032227-2011-01412
    Event Type
    Injury
    Date Received
    June 9, 2011
    Date of Event
    May 25, 2011
    Report Date
    May 25, 2011
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    MDS
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SC, 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 CALLED TO REPORT THAT THE GLUCOSE METER WAS NOT SENDING THE BLOOD GLUCOSE READING TO THE INSULIN PUMP. FOUND THAT THE CUSTOMER'S BLOOD GLUCOSE LEVELS WERE OUT OF RANGE, AND HE HAD NOT TREATED THEM. ASKED THE CUSTOMER IF HE WANTED THE PARAMEDICS TO BE CALLED. THE CUSTOMER DECLINED, AND STATED THAT HE WOULD FIND A WAY TO GET HIMSELF TO THE EMERGENCY ROOM. 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 MINIMED MMT-723RNAP

    Patients

    Seq Age Sex Outcome Treatment
    1 48 YR Hospitalization