BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LANCET DEVICE

    MDR report key: 3790154 · Received May 5, 2014

    Report

    Report Number
    2032227-2014-02241
    Event Type
    Injury
    Date Received
    May 5, 2014
    Date of Event
    March 7, 2014
    Report Date
    April 14, 2014
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    MDS
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AL
    Reporter Occupation
    PATIENT

    Narratives

    Additional Manufacturer Narrative · 1

    INSPECTED ONE OPENED AND USED SENSOR. PERFORMED INSTRUCTION TEST AND SENSOR PASSED PER SPECIFICATIONS. SENSOR INSERTED AND RELEASE PROPERLY.

    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. PLEASE SEE ALSO MFR REPORT NUMBER 3004209178-2014-84136 AND 2032227-2014-02242.

    Description of Event or Problem · 1

    CUSTOMER REPORTED THAT HE WAS HOSPITALIZED DUE TO LOW BLOOD GLUCOSE AND A VIRUS. THE BLOOD GLUCOSE READING WAS 44 MG/DL AT THE TIME OF HOSPITALIZATION. CUSTOMER STATED THAT HE WAS HAVING ISSUES WITH INSULIN PUMP AND SENSOR COMMUNICATION. CUSTOMER STATED THAT HIS SERTER WAS NOT WORKING PROPERLY, THE NEEDLE HUB STUCK IN THE SERTER AND IT WAS NOT RELEASED. NOTHING FURTHER WAS REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    267530 LANCET DEVICE CGM MDS MEDTRONIC MINIMED MMT-7510

    Patients

    Seq Age Sex Outcome Treatment
    1 67 YR Hospitalization