BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SYNCHROMED II

    MDR report key: 14241003 · Received April 28, 2022

    Report

    Report Number
    3004209178-2022-05409
    Event Type
    Injury
    Date Received
    April 28, 2022
    Date of Event
    April 15, 2022
    Report Date
    May 11, 2022
    Manufacturer
    MEDTRONIC PUERTO RICO OPERATIONS CO.
    Product Code
    LKK
    UDI-DI
    00643169100824
    PMA / PMN Number
    P860004
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

    Additional Manufacturer Narrative · 0

    MEDTRONIC IS SUBMITTING THIS REPORT TO COMPLY WITH FDA REPORTING REGULATIONS UNDER 21 CFR PARTS 4 AND 803. THIS REPORT IS BASED UPON INFORMATION OBTAINED BY MEDTRONIC, WHICH THE COMPANY MAY NOT HAVE BEEN ABLE TO FULLY INVESTIGATE OR VERIFY PRIOR TO THE DATE THE REPORT WAS REQUIRED BY THE FDA. MEDTRONIC HAS MADE REASONABLE EFFORTS TO OBTAIN MORE COMPLETE INFORMATION AND HAS PROVIDED AS MUCH RELEVANT INFORMATION AS IS AVAILABLE TO THE COMPANY AS OF THE SUBMISSION DATE OF THIS REPORT. THIS REPORT DOES NOT CONSTITUTE AN ADMISSION OR A CONCLUSION BY FDA, MEDTRONIC, OR ITS EMPLOYEES THAT THE DEVICE, MEDTRONIC, OR ITS EMPLOYEE CAUSED OR CONTRIBUTED TO THE EVENT DESCRIBED IN THE REPORT. IN PARTICULAR, THIS REPORT DOES NOT CONSTITUTE AN ADMISSION BY ANYONE THAT THE PRODUCT DESCRIBED IN THIS REPORT HAS ANY ¿DEFECTS¿ OR HAS ¿MALFUNCTIONED¿. THESE WORDS ARE INCLUDED IN THE FDA 3500A FORM AND ARE FIXED ITEMS FOR SELECTION CREATED BY THE FDA TO CATEGORIZE THE TYPE OF EVENT SOLELY FOR THE PURPOSE OF REGULATORY REPORTING. MEDTRONIC OBJECTS TO THE USE OF THESE WORDS AND OTHERS LIKE THEM BECAUSE OF THE LACK OF DEFINITION AND THE CONNOTATIONS IMPLIED BY THESE TERMS. THIS STATEMENT SHOULD BE INCLUDED WITH ANY INFORMATION OR REPORT DISCLOSED TO THE PUBLIC UNDER THE FREEDOM OF INFORMATION ACT. ANY REQUIRED FIELDS THAT ARE UNPOPULATED ARE BLANK BECAUSE THE INFORMATION IS CURRENTLY UNKNOWN OR UNAVAILABLE. A GOOD FAITH EFFORT WILL BE MADE TO OBTAIN THE APPLICABLE INFORMATION RELEVANT TO THE REPORT. IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

    Description of Event or Problem · 0

    ON (B)(6) 2022, INFORMATION WAS RECEIVED FROM AN HEALTHCARE PROFESSIONAL (HCP), REGARDING A PATIENT RECEIVING GABLOFEN (2,000 MCG/ML, 751.9 MCG/DAY) VIA AN IMPLANTABLE PUMP. IT WAS REPORTED THE PATIENT CAME IN FOR A REFILL ON THE DATE OF THIS CALL AND THE PUMP SHOWED A RESET AND PUMP MEMORY ERROR (PME). THE HCP CHECKED THE PUMP LOGS AND IT SHOWED A LOW BATTERY RESET, PME AND SAFE STATED THAT STARTED (B)(6) 2022 AND HAD ANOTHER RESET (B)(6) 2022. THE HCP STATED THE PATIENT HEARD THE PUMP ALARMING APPROXIMATELY 1 WEEK AGO AND HAS HAD INCREASED STIFFNESS AND WAS TAKING PO BACLOFEN.

    Description of Event or Problem · 0

    ADDITIONAL INFORMATION WAS RECEIVED THAT REPORTED THE ACTIONS TAKEN TO RESOLVE THE ISSUE WAS THE IT PUMP WAS SCHEDULED TO BE REPLACED WITH THE NEUROSURGEON (B)(6) 2022. THE PATIENT WAS TAKING ORAL BACLOFEN AWAITING PUMP REPLACEMENT SURGERY IN JUNE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    99766 SYNCHROMED II PUMP, INFUSION, IMPLANTED, PROGRAMMABLE LKK MEDTRONIC PUERTO RICO OPERATIONS CO. 8637-40 00643169100824

    Patients

    Seq Age Sex Outcome Treatment
    1 38 YR Male Required Intervention