BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP

    MDR report key: 4240502 · Received November 10, 2014

    Report

    Report Number
    2032227-2014-49064
    Event Type
    Malfunction
    Date Received
    November 10, 2014
    Date of Event
    October 11, 2014
    Report Date
    October 11, 2014
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS CO.
    Product Code
    OYC
    PMA / PMN Number
    P980022
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX
    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.(B)(4)

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE CUSTOMER'S BLOOD GLUCOSE WAS 418 MG/DL. SHE HAD RECEIVED A BATTERY OUT LIMIT ALARM, AFTER SHE CHANGED THE BATTERY IN HER INSULIN PUMP. THE CUSTOMER HAD ALSO RECEIVED FAILED BATTERY AND LOW BATTERY ALERTS. THE CUSTOMER WAS ASSISTED IN REPROGRAMMING THE TIME AND DATE IN THE INSULIN PUMP AND WAS ADVISED TO RECONNECT AND TREAT ACCORDINGLY. NOTHING FURTHER WAS REPROTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    724120 PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP INSULIN INFUSION PUMP / SENSOR AUGMENTED OYC MEDTRONIC PUERTO RICO OPERATIONS CO. MMT-523NAS

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR