BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP

    MDR report key: 3981372 · Received August 5, 2014

    Report

    Report Number
    2032227-2014-06072
    Event Type
    Malfunction
    Date Received
    August 5, 2014
    Date of Event
    July 4, 2014
    Report Date
    July 5, 2014
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    OYC
    PMA / PMN Number
    P980022
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    UT
    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

    CUSTOMER REPORTED RECEIVING AN OFF NO POWER ALERT ON THE INSULIN PUMP WHILE TROUBLESHOOTING FOR A MOTOR ERROR ALARM. CUSTOMER WAS UNABLE TO REWIND THE INSULIN PUMP. HE STATED THAT HE DID NOT RECEIVE A LOW BATTERY ALERT PRIOR TO THE INSULIN PUMP SHUTTING DOWN. HE STATED THAT THE BATTERY WAS NOT PREVIOUSLY USED AND THAT THE INSULIN PUMP HAD NOT BEEN DROPPED OR BUMPED. HE STATED THAT THERE WERE NO UNATTENDED ALARMS. THE BLOOD GLUCOSE READING WAS 60 MG/DL. NOTHING FURTHER WAS REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    457623 PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP INSULIN INFUSION PUMP / SENSOR AUGMENTED OYC MEDTRONIC MINIMED MMT-723RNAL

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR