BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PARADIGM REAL-TIME INSULIN INFUSION PUMP

    MDR report key: 4123094 · Received September 26, 2014

    Report

    Report Number
    2032227-2014-29649
    Event Type
    Malfunction
    Date Received
    September 26, 2014
    Date of Event
    August 20, 2014
    Report Date
    August 28, 2014
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    OYC
    PMA / PMN Number
    P980022
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IZ
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE PUMP PASSED THE BASIC OCCLUSION AND DISPLACEMENT TESTS. NO MOTOR ERROR ALARMS WERE NOTED. THE MOTOR WAS TESTED OUTSIDE OF THE DEVICE AND IT PASSED. HOWEVER, UNABLE TO PRIME THE PUMP DURING THE PRIME TEST DUE TO A SLIGHTLY LOOSE DRIVE SUPPORT DISK. THE PUMP ALSO HAD A CRACKED CASE AT THE DISPLAY WINDOW CORNERS, MINOR SCRATCHES ON THE LCD WINDOW, A STAINED END CAP STICKER, AND MISSING SEGMENTS DUE TO A CRACKED ZEBRA CONNECTOR ON THE LCD BOARD.

    Additional Manufacturer Narrative · 1

    (B)(4). CURRENTLY, IT IS UNKNOWN WHETHER OR NOT THE DEVICE MAY HAVE CAUSED OR CONTRIBUTED TO THE EVENT AS NO PRODUCT HAS BEEN RETURNED. THE DEVICE WILL BE RETURNED FOR ANALYSIS AND FURTHER INFORMATION WILL FOLLOW ONCE THE ANALYSIS HAS BEEN COMPLETED. NO CONCLUSION CAN BE DRAWN AT THIS TIME.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE INSULIN PUMP ALARMED MOTOR ERROR. THE CALLER DID NOT KNOW THE BLOOD GLUCOSE READING. ADVISED RETURN OF THE INSULIN PUMP FOR ANALYSIS. NOTHING FURTHER REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    600489 PARADIGM REAL-TIME INSULIN INFUSION PUMP INSULIN INFUSION PUMP / SENSOR AUGMENTED OYC MEDTRONIC MINIMED MMT-722WWL

    Patients

    Seq Age Sex Outcome Treatment
    1