BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP

    MDR report key: 3880230 · Received June 18, 2014

    Report

    Report Number
    3004209178-2014-85663
    Event Type
    Injury
    Date Received
    June 18, 2014
    Date of Event
    March 1, 2014
    Report Date
    May 29, 2014
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS CO.
    Product Code
    OYC
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    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

    CERTIFIED DIABETES EDUCATOR REPORTED HOSPITALIZATION DUE TO HIGH BLOOD GLUCOSE. CALLER STATED THAT THE CUSTOMER'S PHYSICIAN WANTS HER TO RESUME INSULIN PUMP THERAPY. CALLER STATED THAT THE INSULIN PUMP ALARMED. DURING TROUBLESHOOTING, IT IS NORMAL THAT THE INSULIN PUMP ALARMS WHEN STORED WITHOUT A BATTERY. NOTHING FURTHER REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    357994 PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP INSULIN INFUSION PUMP / SENSOR AUGMENTED OYC MEDTRONIC PUERTO RICO OPERATIONS CO. MMT-723NAL

    Patients

    Seq Age Sex Outcome Treatment
    1 26 YR Hospitalization