FDA Adverse Event
Malfunction
Summary report: N
PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP
MDR report key: 3930488
·
Received July 12, 2014
Report
- Report Number
- 2032227-2014-03647
- Event Type
- Malfunction
- Date Received
- July 12, 2014
- Date of Event
- June 2, 2014
- Report Date
- June 11, 2014
- Manufacturer
- MEDTRONIC MINIMED
- Product Code
- OYC
- PMA / PMN Number
- P980022
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- OK
- Reporter Occupation
- PATIENT
Narratives
Additional Manufacturer Narrative · 1
CURRENTLY, IT IS UNKNOWN WHETHER OR NOT THE DEVICE MAY HAVE CAUSED OR CONTRIBUTED TO THE EVENT. THE DEVICE HAS BEEN RETURNED, BUT NOT YET EVALUATED. FURTHER INFORMATION WILL FOLLOW ONCE THE ANALYSIS HAS BEEN COMPLETED. NO CONCLUSION CAN BE DRAWN AT THIS TIME.
Additional Manufacturer Narrative · 1
THE INSULIN PUMP RECEIVED WITH CRACKED DISPLAY WINDOW CORNERS AND SEVERELY SCRATCHED LCD WINDOW.
Description of Event or Problem · 1
CUSTOMER REPORTED THAT HER BLOOD GLUCOSE WAS 103 MG/DL. CUSTOMER STATED THAT SHE GOT DIZZY AND FELL ON THE INSULIN PUMP. CUSTOMER STATED THAT THE SCREEN IS SCRATCHED AND UNABLE TO READ. NOTHING FURTHER WAS REPORTED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 408877 | PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP | INSULIN INFUSION PUMP / SENSOR AUGMENTED | OYC | MEDTRONIC MINIMED | MMT-723LNAH |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 64 YR |