MAUDE Adverse Event Report: MEDTRONIC MINIMED UNKNOWN XMTR; SENSOR, GLUCOSE, INVASIVE

Model Number UNK_TRANSMITTER

Device Problems Display or Visual Feedback Problem (1184); Wireless Communication Problem (3283)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 04/11/2024

Event Type  malfunction  

Manufacturer Narrative

Currently it is unknown whether or not the device may have caused or contributed to the event as no product has been returned.No conclusion can be drawn at this time.We therefore consider this report complete to the best of our knowledge.Select patient information cannot be provided due to regional privacy regulations.Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employees caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.

Event Description

It was reported to medtronic minimed that the customer experienced an led anomaly.The customer reported no adverse event.The event involved product(s) unk_transmitter.Troubleshooting was performed and the customer reported that the pump was not communicating with the transmitter.The customer reports the transmitter did not blink when connected to the sensor.The transmitter was fully charged prior.Led light blinked when the transmitter was disconnected from the charger or connected to the tester but led light would not blink when connected to the sensor.No harm requiring medical intervention was reported.No product return is required for unk_transmitter.

• Brand Name: UNKNOWN XMTR
• Type of Device: SENSOR, GLUCOSE, INVASIVE
• Manufacturer (Section D): MEDTRONIC MINIMED; 18000 devonshire st.; northridge CA 91325
• Manufacturer (Section G): MEDTRONIC MINIMED; 18000 devonshire st.; northridge CA 91325
• Manufacturer Contact: lusine boyadzhyan ; 18000 devonshire st.; northridge, CA 91325
• MDR Report Key: 19189785
• MDR Text Key: 341183930
• Report Number: 2032227-2024-159682
• Device Sequence Number: 1
• Product Code: MDS
• Combination Product (y/n): N
• Reporter Country Code: TC
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Consumer
• Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date: 04/26/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 04/26/2024
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Lay User/Patient
• Device Model Number: UNK_TRANSMITTER
• Device Catalogue Number: UNK_TRANSMITTER
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 04/11/2024
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: A
• Patient Sequence Number: 1