MAUDE Adverse Event Report: MEDTRONIC MINIMED 530G INSULIN PUMP MMT-551LNAL ARTIFICIAL PANCREAS DEVICE SYSTEM, THRESHOLD SUSPEND

Model Number MMT-551LNAL

Device Problems False Reading From Device Non-Compliance (1228); Device Displays Incorrect Message (2591)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 05/01/2018

Event Type  Injury  

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.

Event Description

The customer reported via phone call that they experienced low blood glucose. The low blood glucose was 47 mg/dl. The current blood glucose was 16. 78 mmol/l. The other relevant blood glucose was 124 mg/dl, 180 mg/dl, and 119 mg/dl. Troubleshooting was not performed for low blood glucose. The customer also reported that the sensor had inaccurate readings that triggered threshold suspend alarm. The customer¿s blood glucose was 47 mg/dl and the sensor glucose was 123 mg/dl. Insulin delivery was suspended due to sensor values. Sensor value that triggered the suspend event was 70 mg/dl. Suspend on low limit in sensor settings was 70 mg/dl. The product will be returned for analysis.

• Brand Name: 530G INSULIN PUMP MMT-551LNAL
• Type of Device: ARTIFICIAL PANCREAS DEVICE SYSTEM, THRESHOLD SUSPEND
• Manufacturer (Section D): MEDTRONIC MINIMED; 18000 devonshire st.; northridge CA 91325 1219
• Manufacturer (Section G): MEDTRONIC MINIMED; 18000 devonshire st.; northridge CA 91325 1219
• Manufacturer Contact: gerwin de graaff ; 18000 devonshire st.; northridge, CA 91325-1219
• MDR Report Key: 7555891
• MDR Text Key: 109613778
• Report Number: 2032227-2018-04132
• Device Sequence Number: 1
• Product Code: OZO
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: consumer,other
• Type of Report: Initial
• Report Date: 05/31/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 05/31/2018
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No

Device Operator

• Device Model Number: MMT-551LNAL
• Device Catalogue Number: MMT-551LNAL
• Was Device Available for Evaluation?: No

Was the Report Sent to FDA?

• Event Location: No Information
• Date Manufacturer Received: 05/01/2018
• Was Device Evaluated by Manufacturer?: No Answer Provided
• 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: 05/31/2018 Patient Sequence Number: 1