BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MEDTRONIC MINIMED

    MDR report key: 2177450 · Received July 20, 2011

    Report

    Report Number
    MW5021475
    Event Type
    Injury
    Date Received
    July 20, 2011
    Date of Event
    January 11, 2011
    Report Date
    July 20, 2011
    Manufacturer
    MEDTRONIC
    Product Code
    LZG
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    ND, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    THE PUMP IS OUT OF WARRANTY AS OF (B)(6) 2011, THE SCREEN IS CRACKED AND THERE ARE ISSUES WITH THE DISPLAY COMING UP AFTER CHANGING THE BATTERY. DATES OF USE: (B)(6) 2007 -- (B)(6) 2011.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDTRONIC MINIMED INSULIN PUMP LZG MEDTRONIC MMT722

    Patients

    Seq Age Sex Outcome Treatment
    1 43 YR Life Threatening| S