BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP

    MDR report key: 3092933 · Received May 3, 2013

    Report

    Report Number
    2032227-2013-01630
    Event Type
    Injury
    Date Received
    May 3, 2013
    Date of Event
    April 3, 2013
    Report Date
    April 8, 2013
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    OYC
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL
    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

    THE CUSTOMER REPORTED THAT HE WAS HOSPITALIZED DUE TO LOW BLOOD GLUCOSE LEVELS. THE CUSTOMER'S BLOOD GLUCOSE WAS 15 MG/DL WHEN THE PARAMEDICS ARRIVED, AND 28 MG/DL WHEN ADMITTED TO THE HOSPITAL. THE CUSTOMER HAD BEEN WORKING OUTSIDE ON HIS YARD, AND KNEW HIS BLOOD GLUCOSE LEVELS WERE LOW, BUT HE DIDN'T STOP TO EAT ANYTHING. THE CUSTOMER STATED THAT HE USUALLY WEARS A SENSOR, BUT HE WAS NOT WEARING IT THAT DAY. NOTHING FURTHER WAS REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    195236 PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP INSULIN INFUSION PUMP / SENSOR AUGMENTED OYC MEDTRONIC MINIMED MMT-723LNAS

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Hospitalization