BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM REAL-TIME INSULIN INFUSION PUMP

    MDR report key: 3083623 · Received April 29, 2013

    Report

    Report Number
    3004209178-2013-92873
    Event Type
    Injury
    Date Received
    April 29, 2013
    Date of Event
    August 1, 2012
    Report Date
    April 5, 2013
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS CO.
    Product Code
    OYC
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL
    Reporter Occupation
    PATIENT

    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

    IT WAS REPORTED THAT CUSTOMER CALLED IN RESPONSE TO THE FIELD NOTIFICATION LETTER, SHE HAD A CONCERN REGARDING THE DRIVE SUPPORT CAP. EXPLAINED THE LOCATION AND FUNCTION OF THE DRIVE SUPPORT CAP. NO DAMAGE TO DRIVE SUPPORT CAP. CUSTOMER STATED THAT SHE WAS HOSPITALIZED IN AUGUST 2012 WITH A BLOOD GLUCOSE READING OF 993 MG/DL. NOTHING FURTHER REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    185082 PARADIGM REAL-TIME INSULIN INFUSION PUMP INSULIN INFUSION PUMP / SENSOR AUGMENTED OYC MEDTRONIC PUERTO RICO OPERATIONS CO. MMT-722NAS

    Patients

    Seq Age Sex Outcome Treatment
    1 64 YR Hospitalization