BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM REAL-TIME INSULIN INFUSION PUMP

    MDR report key: 3903427 · Received June 30, 2014

    Report

    Report Number
    3004209178-2014-86189
    Event Type
    Injury
    Date Received
    June 30, 2014
    Date of Event
    June 10, 2014
    Report Date
    June 13, 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

    NURSE PRACTITIONER REPORTED THE HOSPITALIZATION DUE TO DIABETES KETOACIDOSIS. THE BLOOD GLUCOSE READING AT THE TIME OF THE EVENT WAS 860 MG/DL. THE BLOOD GLUCOSE LEVELS KEPT CLIMBING. NURSE TRIED TO TREAT WITH BOLUS. CALLER STATED THAT CUSTOMER HAS BEEN HOSPITALIZED TWICE FOR LOW BLOOD GLUCOSE. CUSTOMER WILL BE DISCHARGED OVER THE WEEKEND. NOTHING FURTHER REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    379896 PARADIGM REAL-TIME INSULIN INFUSION PUMP INSULIN INFUSION PUMP / SENSOR AUGMENTED OYC MEDTRONIC PUERTO RICO OPERATIONS CO. MMT-722LNAS

    Patients

    Seq Age Sex Outcome Treatment
    1 48 YR Hospitalization