BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM REAL-TIME INSULIN INFUSION PUMP

    MDR report key: 2243546 · Received September 2, 2011

    Report

    Report Number
    3004209178-2011-82813
    Event Type
    Injury
    Date Received
    September 2, 2011
    Date of Event
    August 21, 2011
    Report Date
    August 21, 2011
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS CO., JUNCOS
    Product Code
    MDS
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OK, 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. THE DEVICE HAS BEEN RETURNED, BUT NOT YET EVALUATED. NO CONCLUSION CAN BE DRAWN AT THIS TIME. FURTHER INFO WILL FOLLOW ONCE THE ANALYSIS HAS BEEN COMPLETED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE CUSTOMER WAS ADMITTED AT THE INTENSIVE CARE UNIT DUE TO HIGH BLOOD GLUCOSE. THE AUNT STATED THAT THE INSULIN PUMP WAS NOT FUNCTIONING. THE CUSTOMER'S BROTHER CALLED BACK AND REQUESTED A REPLACEMENT OF THE INSULIN PUMP. THE BROTHER STATED THAT THE CUSTOMER'S BLOOD GLUCOSE WAS ABOUT 500MG/DL AT TIME OF HIS ADMISSION. NO FURTHER INFO WAS PROVIDED.

    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 CO., JUNCOS MMT-522NAB

    Patients

    Seq Age Sex Outcome Treatment
    1 31 YR Hospitalization