BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARADIGM REAL-TIME INSULIN INFUSION PUMP

    MDR report key: 4110739 · Received September 23, 2014

    Report

    Report Number
    2032227-2014-27937
    Event Type
    Injury
    Date Received
    September 23, 2014
    Date of Event
    August 25, 2014
    Report Date
    August 25, 2014
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    OYC
    PMA / PMN Number
    P980022
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    PATIENT FAMILY MEMBER OR FRIEND

    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. (B)(4).

    Description of Event or Problem · 1

    IT WAS REPORTED BY CUSTOMER'S FATHER THAT THEY HAD BEEN HOSPITALIZED FOR HIGH BLOOD GLUCOSE LEVELS ON (B)(6) 2014. CUSTOMER'S BLOOD GLUCOSE LEVEL WAS 378 MG/DL AT TIME OF HOSPITALIZATION AND WAS GIVEN INTRAVENOUS INSULIN DRIP WHILE IN THE HOSPITAL. CUSTOMER'S FATHER STATED THE CUSTOMER WAS NOT TREATING BLOOD GLUCOSE LEVELS PROPERLY AND IT WAS USER ERROR. CUSTOMER DECLINED TROUBLESHOOTING. NOTHING FURTHER REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    590317 PARADIGM REAL-TIME INSULIN INFUSION PUMP INSULIN INFUSION PUMP / SENSOR AUGMENTED OYC MEDTRONIC MINIMED MMT-722NAS

    Patients

    Seq Age Sex Outcome Treatment
    1 20 YR Hospitalization