BEUDAMED
    FDA Adverse Event Death Summary report: N

    530G INSULIN PUMP

    MDR report key: 3903574 · Received June 30, 2014

    Report

    Report Number
    3004209178-2014-86352
    Event Type
    Death
    Date Received
    June 30, 2014
    Date of Event
    April 5, 2014
    Report Date
    June 17, 2014
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS CO.
    Product Code
    OZO
    PMA / PMN Number
    P120010
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    PATIENT FAMILY MEMBER OR FRIEND

    Narratives

    Additional Manufacturer Narrative · 1

    A COMPLETE ANALYSIS AND TESTING OF THE INSULIN PUMP SHOWED THAT IT WAS FUNCTIONING PROPERLY AND PASSED ALL FUNCTIONAL TESTING. AFTER TESTING IT WAS CONCLUDED THAT THE DEVICE OPERATED WITHIN SPECIFICATIONS.

    Description of Event or Problem · 1

    CUSTOMER'S HUSBAND REPORTED THE DEATH OF HIS WIFE. CALLER STATED THAT CUSTOMER WAS IN THE HOSPITAL CONSTANTLY. CUSTOMER WAS NOT WEARING THE INSULIN PUMP AT THE TIME OF DEATH. CALLER STATED THAT CUSTOMER WAS DIAGNOSED WITH GASTROPARESIS AND COULD NOT HAVE SURGERY. NOTHING FURTHER REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    379490 530G INSULIN PUMP OZO OZO MEDTRONIC PUERTO RICO OPERATIONS CO. MMT-751NAH

    Patients

    Seq Age Sex Outcome Treatment
    1 41 YR Death