MAUDE Adverse Event Report: MEDTRONIC MINIMED PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP MMT-723LNAS; PUMP, INFUSION, INSULIN, TO BE USED WITH INVASIVE GLUCOSE SENSOR

Model Number	MMT-723LNAS
Medical Device Problem Codes	Electrical /Electronic Property Problem (1198); Battery Problem (2885)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	11/10/2019
Type of Reportable Event	Malfunction
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.No conclusion can be drawn at this time.We therefore consider this report complete to the best of our knowledge.
Event or Problem Description
Customer reported via phone call that the insulin pump had e008 code and a codes a couple times had to restart and reprime the insulin pump to clear error code.Customer's blood glucose level was unknown.Customer also reported that the insulin pump had diminished battery life.The device will not be returned for analysis.
Additional Manufacturer Narrative
Device monitored for several days.Device received with normal operating current.Device passed displacement test and self test.Device passed off no power test.No unexpected e08 alarm anomalies noted.No unexpected low battery alarm anomalies noted.
Additional Manufacturer Narrative
Device monitored for several days.Device received with normal operating current.Device passed displacement test and self test.Device passed off no power test.No unexpected low battery alarm anomalies noted.

• Brand Name: PARADIGM REAL-TIME REVEL INSULIN INFUSION PUMP MMT-723LNAS
• 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: 9333119
• Report Number: 2032227-2019-118744
• Device Sequence Number: 1926996
• Product Code: OYC
• UDI-Device Identifier: 00613994904485
• UDI-Public: (01)00613994904485
• Combination Product (Y/N): N
• Initial Reporter State: IN
• 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,Followup,Followup
• Report Date (Section B): 09/02/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Lay User/Patient
• Device Model Number: MMT-723LNAS
• Device Catalogue Number: MMT-723LNAS
• Device Lot Number: A000202771
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 01/02/2020
• Initial Date Received by Manufacturer: 11/10/2019
• Supplement Date Received by Manufacturer: 08/31/2020; 09/01/2020
• Initial Report FDA Received Date: 11/16/2019
• Supplement Report FDA Received Date: 09/01/2020; 09/03/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 58 YR
• Patient Weight: 239