MAUDE Adverse Event Report: MEDTRONIC PUERTO RICO OPERATIONS CO. 530G INSULIN PUMP OZO

Model Number MMT-751NAL

Device Problem False Reading From Device Non-Compliance (1228)

Patient Problems Hypoglycemia (1912); Overdose (1988)

Event Date 08/30/2015

Event Type  Injury  

Manufacturer Narrative

Reference medwatch 2032227-2015-46399 for additional information. 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. (b)(4).

Event Description

The customer reported via phone call that the sensor reading was inaccurate and as a result he over treated a low blood glucose level. The customer was having sensor and blood glucose reading issues. The customer received sensor errors. Customer's blood glucose level was 50 mg/dl. He treated his low blood glucose with food. The device was not returned.

• Brand Name: 530G INSULIN PUMP
• Type of Device: OZO
• Manufacturer (Section D): MEDTRONIC PUERTO RICO OPERATIONS CO.; ceiba norte ind. park #50; road 31 km 24.4; juncos PR 00777 3869
• Manufacturer (Section G): MEDTRONIC MINIMED; 18000 devonshire street; northridge CA 91325 1219
• Manufacturer Contact: gerwin de graaff ; 18000 devonshire street; northridge, CA 91325-1219 ; 8185764805
• MDR Report Key: 5089328
• MDR Text Key: 26228135
• Report Number: 2032227-2015-46197
• Device Sequence Number: 1
• Product Code: OZO
• Combination Product (Y/N): N
• PMA/PMN Number: 120010
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: CONSUMER
• Reporter Occupation: PATIENT
• Type of Report: Initial
• Report Date: 08/30/2015

1 Device Was Involved in the Event

1 Patient Was Involved in the Event

• Date FDA Received: 09/18/2015
• Is This An Adverse Event Report?: Yes
• Is This A Product Problem Report?: No
• Device Operator: LAY USER/PATIENT
• Device MODEL Number: MMT-751NAL
• Device Catalogue Number: MMT-751NAL
• Was Device Available For Evaluation?: No
• Is The Reporter A Health Professional?: No

Was the Report Sent to FDA?

• Event Location: No Information
• Date Manufacturer Received: 08/30/2015
• Was Device Evaluated By Manufacturer?: Device Not Returned To Manufacturer
• Is The Device Single Use?: No
• Is this a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unkown

Patient TREATMENT DATA

Date Received: 09/18/2015 Patient Sequence Number: 1