BEUDAMED
    FDA Adverse Event Death Summary report: N

    MINIMED MEDTRONICS

    MDR report key: 507337 · Received January 13, 2004

    Report

    Report Number
    MW1030822
    Event Type
    Death
    Date Received
    January 13, 2004
    Manufacturer
    MINIMED MEDTRONICS
    Product Code
    LZG
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PT WAS USING 507 MINIMED INSULIN INFUSION PUMP. PUMP FAILED, IE; NO INSULIN DELIVERY "BLANK SCREEN". HUMALOG WAS USED IN THE PUMP. PT DIED FROM HYPEROSMALAR DIABETIC COMA (APPROX 8 HOURS).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MINIMED MEDTRONICS INSULIN INFUSION PUMP LZG MINIMED MEDTRONICS 507 *

    Patients

    Seq Age Sex Outcome Treatment
    1 33 YR Death