BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP

    MDR report key: 3864552 · Received June 10, 2014

    Report

    Report Number
    2032227-2014-02966
    Event Type
    Injury
    Date Received
    June 10, 2014
    Date of Event
    May 15, 2014
    Report Date
    May 15, 2014
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    OYC
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    PATIENT FAMILY MEMBER OR FRIEND

    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

    HOSPITALIZATION REPORTED DUE TO HIGH BLOOD GLUCOSE. DIAGNOSED DIABETES KETOACIDOSIS. THE CUSTOMER'S BLOOD GLUCOSE WAS 527 MG/DL AT THE TIME OF HOSPITALIZATION. CUSTOMER WAS VOMITING FOR SEVERAL HOURS. LARRY ALSO STATED THAT THE CUSTOMER WAS WEARING THE INSULIN PUMP AT THE TIME OF HOSPITALIZATION AND WAS CALLING BECAUSE HE WANTED TO KNOW IF THE INSULIN PUMP WAS WORKING. THE CURRENT BLOOD GLUCOSE READING IS 159 MG/DL. NOTHING FURTHER REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    339016 PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP INSULIN INFUSION PUMP / SENSOR AUGMENTED OYC MEDTRONIC MINIMED MMT-723LNAS

    Patients

    Seq Age Sex Outcome Treatment
    1 18 YR Hospitalization