BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    530G INSULIN PUMP

    MDR report key: 3943010 · Received July 17, 2014

    Report

    Report Number
    3004209178-2014-87660
    Event Type
    Malfunction
    Date Received
    July 17, 2014
    Date of Event
    May 28, 2014
    Report Date
    June 17, 2014
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS CO.
    Product Code
    OZO
    PMA / PMN Number
    120010
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH
    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 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

    THE CUSTOMER REPORTED THAT THE SENSOR READINGS WERE NOT ACCURATE. THE BLOOD GLUCOSE READING WAS NOT GIVEN. THE PATIENT STATED THAT THERE WERE DISCREPANCIES BETWEEN THE BLOOD GLUCOSE LEVEL AND THE SENSOR'S READINGS. THE CUSTOMER WAS ADVISED TO CALL FOR ASSISTANCE IF THERE ARE CALIBRATION ERRORS. NO FURTHER INFORMATION WAS PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    419899 530G INSULIN PUMP OZO OZO MEDTRONIC PUERTO RICO OPERATIONS CO. MMT-751NAS

    Patients

    Seq Age Sex Outcome Treatment
    1 32 YR