BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PUMP, INSULIN, 712 NA PURPLE

    MDR report key: 562065 · Received December 28, 2004

    Report

    Report Number
    2032227-2004-02378
    Event Type
    Injury
    Date Received
    December 28, 2004
    Date of Event
    December 7, 2004
    Report Date
    December 7, 2004
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    LZG
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OR, US
    Reporter Occupation
    INVALID DATA

    Narratives

    Description of Event or Problem · 1

    CUSTOMER REPORTED BEING HOSPITALIZED DUE TO DRUG INTERACTION AND HBG AS PER MD. CUSTOMER HAD HBG FOR 2 DAYS AND STARTED VALIUM SAME DAY. INSTRUCTED CUSTOMER TO MONITOR BG, EXPLAINED 2 HBG RULE AND CALL BACK FOR HP TEST WHEN CLAMP ARRIVES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PUMP, INSULIN, 712 NA PURPLE INFUSION PUMP LZG MEDTRONIC MINIMED MMT-712NAP *

    Patients

    Seq Age Sex Outcome Treatment
    1 61 YR Hospitalization