BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SENSOR ENLITE

    MDR report key: 4233654 · Received November 6, 2014

    Report

    Report Number
    2032227-2014-48920
    Event Type
    Malfunction
    Date Received
    November 6, 2014
    Date of Event
    October 6, 2014
    Report Date
    October 9, 2014
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    OZO
    PMA / PMN Number
    120010
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA
    Reporter Occupation
    OTHER

    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

    IT WAS REPORTED THAT THE CUSTOMER'S SENSOR GLUCOSE AND BLOOD GLUCOSE READING VALUES WERE OFF BY 100 POINTS. THE CUSTOMER'S BLOOD GLUCOSE LEVEL WAS AROUND 200 MG/DL. A BENT CANNULA WAS ALSO REPORTED. THE PRODUCT WAS NOT RETURNED. NOTHING FURTHER TO REPORT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    715505 SENSOR ENLITE OZO OZO MEDTRONIC MINIMED MMT-7008A F164U

    Patients

    Seq Age Sex Outcome Treatment
    1 12 YR