BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    530G INSULIN PUMP

    MDR report key: 4243989 · Received November 11, 2014

    Report

    Report Number
    2032227-2014-50369
    Event Type
    Malfunction
    Date Received
    November 11, 2014
    Date of Event
    October 14, 2014
    Report Date
    October 14, 2014
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS CO.
    Product Code
    OZO
    PMA / PMN Number
    120010
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    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 HAD RECEIVED AN ALARM ON MONDAY, (B)(6) 2014 AND COUNTING UP FROM 1 TO 8 AND THEN THE PUMP RESET ITSELF. EVER SINCE THEN, THE PUMP HAS BEEN NORMAL. CUSTOMER'S BLOOD GLUCOSE LEVEL WAS 170 MG/DL AND THEIR MOST CURRENT READING WAS 141 MG/DL. CUSTOMER HAD A DISPLAYABLE HISTORY CHECK FAILED ON STARTUP ALERT. CUSTOMER DECLINED TROUBLESHOOTING SINCE THE PUMP WAS WORKING CORRECTLY. CUSTOMER RAN SELF TEST AND THE PUMP PASSED. NO FURTHER ASSISTANCE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    725252 530G INSULIN PUMP OZO OZO MEDTRONIC PUERTO RICO OPERATIONS CO. MMT-751NAS

    Patients

    Seq Age Sex Outcome Treatment
    1 18 YR