BEUDAMED
    FDA Adverse Event Injury Summary report: N

    STANDARD PERCUTANEOUS TRIAL LEAD

    MDR report key: 1790644 · Received August 6, 2010

    Report

    Report Number
    1627487-2010-01511
    Event Type
    Injury
    Date Received
    August 6, 2010
    Date of Event
    October 22, 2007
    Report Date
    November 2, 2007
    Manufacturer
    ADVANCED NEUROMODULATION SYSTEMS
    Product Code
    LGW
    PMA / PMN Number
    P010032
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MD, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    DEVICE 2 OF 2. THE DEVICE HISTORY AND STERILIZATION RECORDS WERE REVIEWED. RESULTS: THE DEVICE HISTORY AND STERILIZATION RECORDS REVIEWED WERE FOUND TO MEET SPECS AND NO ANOMALIES WERE FOUND. THE LEAD AS RETURNED HAS MULTIPLE CUTS, INSTRUMENT MARKS AND COMPRESSION DAMAGE. THE TERMINAL END ELECTRODE IS MISSING AND WAS FOUND INSIDE THE IPG HEADER. CHANNEL 1 AND CHANNEL 5 MEASURE OPEN. ALL OTHER CHANNELS MEASURE LESS THAN 4 OHMS. IT IS BELIEVED THE DAMAGE TO THE PRODUCT HAPPENED DURING THE EXPLANT PROCEDURE. CONCLUSION: THE CAUSE OF THE REPORTED COMPLAINT COULD NOT BE DETERMINED FROM THE REVIEW OF THE DHR AND STERILIZATION RECORDS. THIS MDR IS BEING SUBMITTED PAST THE 30 DAY REPORTING REQUIREMENT AS PART OF A RETROSPECTIVE REVIEW INITIATED IN RESPONSE TO AN FDA INSPECTION. A RETROSPECTIVE REVIEW OF THE COMPLAINT RECORD DETERMINED THAT ANS MISINTERPRETED THE MDR REGULATIONS IN THIS INSTANCE. ANS HAS LIMITED INFO RELATED TO THE PT¿S MEDICAL HISTORY AND IS UNABLE TO FORM AN OPINION AS TO THE RELEVANCY OF THE PT¿S HISTORY TO THE EVENT REPORTED. ANS DEFERS TO THE PT¿S PHYSICIAN REGARDING MEDICAL HISTORY.

    Description of Event or Problem · 1

    DEVICE 2 OF 3. SEE MFR REPORT 1627487-2010-01520 AND 1627487-2010-01530. THE PT RECEIVED HER SC SYSTEM ON (B)(6) 2009. IT WAS REPORTED THAT THE PT CHOSE TO HAVE THE SYSTEM REMOVED BECAUSE SHE WAS NOT SATISFIED WITH THE RESULTS. REPROGRAMMING WAS ATTEMPTED SEVERAL TIMES WITH NO SUCCESS. THE PT'S IPG AND LEAD WERE EXPLANTED ON (B)(6) 2009 AND RETURNED TO THE MFR FOR EVAL. NO FURTHER INFO IS AVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 STANDARD PERCUTANEOUS TRIAL LEAD SPINAL CORD STIMULATION LEAD LGW ADVANCED NEUROMODULATION SYSTEMS 3086 175675

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention