MAUDE Adverse Event Report: MEDTRONIC MINIMED PARADIGM REAL-TIME INSULIN INFUSION PUMP MMT-722RNAP; PUMP, INFUSION, INSULIN, TO BE USED WITH INVASIVE GLUCOSE SENSOR

Model Number	MMT-722RNAP
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Hyperglycemia (1905); Hypoglycemia (1912)
Date of Event	06/25/2018
Type of Reportable Event	Serious Injury
Additional 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.The device will be returned for analysis and further information will follow once the analysis has been completed.No conclusion can be drawn at this time.
Event or Problem Description
Customer reported via phone call that they experienced low blood glucose levels of mg/dl 46 mg/dl.Customer feel ok to troubleshoot.Customer has been using insulin pump system within 48 hours of reported low bg event.Drive support was normal.Customer blood glucose reading at the time of incident was 46 mg/dl.Customer's blood glucose reading was 197 mg/dl at the time of call.Customer low blood glucose reading was treated with food.Customer did not report over delivery.Customer treated their blood glucose reading with glucose tablets.Customer changed their set on june 25, 2018.Customer was advised to call their healthcare provider.The insulin pump had power loss, low battery alert less than a week and unexpected restart.The product was not returned.

• Brand Name: PARADIGM REAL-TIME INSULIN INFUSION PUMP MMT-722RNAP
• Common Device Name: PUMP, INFUSION, INSULIN, TO BE USED WITH INVASIVE GLUCOSE SENSOR
• Manufacturer (Section D): MEDTRONIC MINIMED; 18000 devonshire st.; northridge CA 91325 1219
• MDR Report Key: 7717050
• Report Number: 2032227-2018-08648
• Device Sequence Number: 1065645
• Product Code: OYC
• UDI-Device Identifier: 00613994409164
• UDI-Public: (01)00613994409164
• Combination Product (Y/N): N
• Initial Reporter State: OH
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: consumer
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 07/24/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Lay User/Patient
• Device Model Number: MMT-722RNAP
• Device Catalogue Number: MMT-722RNAP
• Device Lot Number: A000114571
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/25/2018
• Initial Report FDA Received Date: 07/24/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other
• Patient Age: 57 YR
• Patient Weight: 307