BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OCTRODE PERCUTANEOUS TRIAL LEAD

    MDR report key: 1895426 · Received November 4, 2010

    Report

    Report Number
    1627487-2010-03524
    Event Type
    Injury
    Date Received
    November 4, 2010
    Date of Event
    October 8, 2010
    Report Date
    October 8, 2010
    Manufacturer
    ST. JUDE MEDICAL - NEUROMODULATION
    Product Code
    LGW
    PMA / PMN Number
    P010032
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    METHOD: THE DEVICE HISTORY AND STERILIZATION RECORDS WERE REVIEWED. RESULTS: A REVIEW OF THE DHR FOUND A NONCONFORMANCE RELATED TO THE PRODUCT, HOWEVER, THE NONCONFORMANCE WAS IDENTIFIED AS A COSMETIC ISSUE AND DID NOT AFFECT PRODUCT INTEGRITY OR PRODUCT FUNCTIONALITY AND WAS APPROVED FOR USE. THE DHR ANOMALY IS NOT RELATED TO THE ALLEGED DEVICE FAILURE. CONCLUSION: THE CAUSE OF THE REPORTED COMPLAINT COULD NOT BE DETERMINED FROM THE REVIEW OF THE DHR AND STERILIZATION RECORDS. SJM HAS LIMITED INFORMATION 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. SJM DEFERS TO THE PT'S PHYSICIAN REGARDING MEDICAL HISTORY.

    Description of Event or Problem · 1

    THE PT REC'D A TRIAL SCS SYSTEM, INCLUDING A PERCUTANEOUS LEAD, ON (B)(6) 2010. ON (B)(6) 2010, THE PT REPORTEDLY PRESENTED TO THE EMERGENCY ROOM COMPLAINING OF INTENSE BACK PAIN AND NUMBNESS IN HER RIGHT FOOT. THE PT WAS ADMITTED TO THE NEUROLOGICAL INTENSIVE CARE UNIT. THE LEAD WAS EXPLANTED AND NOT REPLACED. THE NEXT DAY, THE PT WAS TAKEN BACK TO SURGERY AS A BLOOD CLOT HAD FORMED POST-OPERATIVE. THE EXPLANTED LEAD WAS DISCARDED BY THE FACILITY. F/U ON THE PT FOUND THAT SHE IS DOING WELL AND THE NUMBNESS IS REPORTEDLY DISSIPATING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 OCTRODE PERCUTANEOUS TRIAL LEAD SPINAL CORD STIMULATION LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3086 3139136

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization| L| R| S