BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PUMP, US, INSULIN, 508, WHITE

    MDR report key: 571208 · Received February 8, 2005

    Report

    Report Number
    2032227-2005-00055
    Event Type
    Injury
    Date Received
    February 8, 2005
    Date of Event
    January 19, 2005
    Report Date
    January 19, 2005
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    LZG
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    INVALID DATA

    Narratives

    Description of Event or Problem · 1

    CUSTOMER REPORTED BEING TREATED AT THE HOSPITAL FOR HIGH AND LOW BG. CUSTOMER REPORTED TAKING LASIKS FOR WATER RETENTION AND PROCRIT ONCE A WEEK. TROUBLESHOOTING PERFORMED PUMP APPEARED O BE FUNCTIONING AS DESIGNED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PUMP, US, INSULIN, 508, WHITE INFUSION PUMP LZG MEDTRONIC MINIMED MMT-508UW *

    Patients

    Seq Age Sex Outcome Treatment
    1 58 YR Required Intervention