530G INSULIN PUMP MMT-751NAB

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a consumer report with the FDA on 2020-03-31 for 530G INSULIN PUMP MMT-751NAB manufactured by Medtronic Puerto Rico Operations Co..

Event Text Entries

[186357278] 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. Pump received with blank display and constant tone due to moisture damage on the electronics assembly. Unable to perform all functional testing including the operating currents, a21 error test, rewind, basic occlusion, occlusion, prime/a33 and excessive no delivery test or verify prime/fill anomaly, rewind anomaly and excessive no delivery alarm due to blank display. Pump received with moisture damage motor, vibrator and battery tube assembly. Pump received with cracked battery tube threads. The p-cap locks into the reservoir compartment properly noted. (b)(4).
Patient Sequence No: 1, Text Type: N, H10


[186357279] Information received by medtronic indicated that the insulin pump had a cracks in the battery area, no delivery alarm. Customer stated that it was louder during rewinding and priming. No harm requiring medical intervention was reported. The insulin pump will be returned for analysis.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number3004209178-2020-92485
MDR Report Key9908917
Report SourceCONSUMER
Date Received2020-03-31
Date of Report2020-03-31
Date of Event2019-06-20
Date Mfgr Received2020-03-23
Device Manufacturer Date2015-06-04
Date Added to Maude2020-03-31
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactGERWIN DE GRAAFF
Manufacturer StreetCEIBA NORTE IND. PARK #50 ROAD
Manufacturer CityJUNCOS 00777-386
Manufacturer Country*
Manufacturer Postal00777-3869
Manufacturer Phone8185464805
Manufacturer G1MEDTRONIC PUERTO RICO OPERATIONS CO.
Manufacturer StreetCEIBA NORTE IND. PARK #50 ROAD
Manufacturer CityJUNCOS 00777-386
Manufacturer Country*
Manufacturer Postal Code00777-3869
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand Name530G INSULIN PUMP MMT-751NAB
Generic NameARTIFICIAL PANCREAS DEVICE SYSTEM, THRESHOLD SUSPEND
Product CodeOZO
Date Received2020-03-31
Returned To Mfg2019-10-22
Model NumberMMT-751NAB
Catalog NumberMMT-751NAB
Lot NumberA4751NABJ
OperatorLAY USER/PATIENT
Device AvailabilityR
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerMEDTRONIC PUERTO RICO OPERATIONS CO.
Manufacturer AddressCEIBA NORTE IND. PARK #50 ROAD JUNCOS 00777-386 * 00777-3869


Patients

Patient NumberTreatmentOutcomeDate
10 2020-03-31

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