BEUDAMED
    FDA Adverse Event Death Summary report: N

    PUMP, INSULIN, 512 NA BLUE

    MDR report key: 555161 · Received November 16, 2004

    Report

    Report Number
    2032227-2004-02138
    Event Type
    Death
    Date Received
    November 16, 2004
    Date of Event
    October 26, 2004
    Report Date
    October 26, 2004
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    LZG
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AZ, US
    Reporter Occupation
    INVALID DATA

    Narratives

    Description of Event or Problem · 1

    THEY CALLED TO REPORT CUSTOMER PASSED AWAY IN 12/2003 DUE TO A CAR ACCIDENT. THEY STATED CUSTOMER WAS WEARING THE PUMP AT THE TIME OF ACCIDENT. THEY ALSO STATES CUSTOMER DID NOT HAVE THEIR SEAT BELT ON; THEY DONATED THE PUMP TO HOSPITAL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PUMP, INSULIN, 512 NA BLUE INFUSION PUMP LZG MEDTRONIC MINIMED MMT-512NAB *

    Patients

    Seq Age Sex Outcome Treatment
    1 47 YR Death