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MiniMed 600 Series Pump Retainer Ring

Pump Replacement Request Form

Please complete the information below to record your response to this important recall notification.
For more information, please visit the Product and Service Information Updates page.
If you have issues viewing or accessing the form on your mobile device, please use a computer.

CLEAR RETAINER RING PUMP (SUBJECT OF RECALL) BLACK RETAINER RING PUMP (NOT AFFECTED BY RECALL)
MiniMed™ pump with clear retainer ring MiniMed™ pump with black retainer ring

Normal pump with black retainer ring
Option Explanation
Request a replacement and return pump with clear retainer ring I want to receive replacement for my clear retainer ring pump when available and will return my clear retainer ring pump upon receipt of replacement product.
IMPORTANT: Medtronic recommends consulting with your healthcare provider regarding the best option for you considering the safety considerations.
I do not need replacement pump and will return my pump with clear retainer ring I already have been issued a replacement pump with a black retainer ring or no longer use my pump with a clear retainer ring, but still have the clear retainer ring pump in my possession, which I will return to Medtronic.
I do not have a pump with clear retainer ring I do not have the clear retainer ring pump in my possession.
I do not want to replace or return my pump with clear retainer ring I do not want to replace my clear retainer ring pump and will not return my clear retainer ring pump to Medtronic at this time.
IMPORTANT: Medtronic strongly recommends replacing the clear retainer ring pump. Before choosing this option, Medtronic recommends consulting with your healthcare professional.



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