BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PUMP,INSULIN, 512 WW BLUE

    MDR report key: 643113 · Received October 27, 2005

    Report

    Report Number
    2032227-2005-01813
    Event Type
    Injury
    Date Received
    October 27, 2005
    Date of Event
    October 1, 2005
    Report Date
    October 7, 2005
    Manufacturer
    MEDTRONIC MINIMED
    Product Code
    LZG
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT HTE CUSTOMER WAS HOSPITALIZED FOR HIGH GLUCOSE LEVEL. TROUBLESHOOTING WAS PERFORMED. THE SELF-TEST PASSED AND NO ANOMALIES FOUND IN MEMORY.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 * Hospitalization