BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP

    MDR report key: 2234036 · Received August 29, 2011

    Report

    Report Number
    3004209178-2011-82741
    Event Type
    Injury
    Date Received
    August 29, 2011
    Date of Event
    August 15, 2011
    Report Date
    August 15, 2011
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS MED-REL
    Product Code
    MDS
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    CURRENTLY, IT IS UNK 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 REPORTED BEING HOSPITALIZED DUE TO HYPERGLYCEMIA AND CONVULSIONS. THE CUSTOMER STATED THAT THERE WAS A DIFFERENCE BETWEEN THE READING OF THE GLUCOSE SENSOR AND THE ACTUAL BLOOD GLUCOSE. THE CUSTOMER'S MOST RECENT GLUCOSE READING WAS 70MG/DL. THE CUSTOMER STATED THAT HE WAS CONNECTED DURING REWIND/PRIME PROCESS. REVIEWED THE PRIMING TECHNIQUE AND NOTHING WAS FOUND. THE PROGRAMMING SEEMS FINE. THE CUSTOMER STATED THAT HE WAS IN CONVULSION, AND GLUCOSE WAS DELIVERED BY HIS SPOUSE. WHEN THE PARAMEDICS ARRIVED HIS BLOOD GLUCOSE WAS 111MG/DL. NO FURTHER INFO WAS PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP INSULIN INFUSION PUMP MDS MEDTRONIC PUERTO RICO OPERATIONS MED-REL MMT-723NAB

    Patients

    Seq Age Sex Outcome Treatment
    1 48 YR Hospitalization