BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DUAL LEAD EXTENSION

    MDR report key: 1904106 · Received October 28, 2010

    Report

    Report Number
    1627487-2010-02197
    Event Type
    Injury
    Date Received
    October 28, 2010
    Date of Event
    December 9, 2008
    Report Date
    December 9, 2008
    Manufacturer
    ADVANCED NEUROMODULATION SYSTEMS
    Product Code
    LGW
    PMA / PMN Number
    P010032
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    EVAL METHOD: THE DEVICE HISTORY AND STERILIZATION RECORDS WERE REVIEWED. RESULTS: THE DEVICE HISTORY AND STERILIZATION RECORDS REVIEWED WERE FOUND TO MEET SPECIFICATIONS AND NO ANOMALIES WERE FOUND. NO TESTING PERFORMED ON INCOMPLETE EXTENSIONS. CONCLUSION: THE CAUSE OF THE REPORTED COMPLAINT COULD NOT BE DETERMINED FROM THE REVIEW OF THE DHR AND STERILIZATION RECORDS. (B)(4). 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 5 OF 5. REFERENCE MFR REPORT 1627487-2010-02194, 1627487-2010-02195, 1627487-2010-02196 & 1627487-2010-02193.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DUAL LEAD EXTENSION SPINAL CORD STIMULATION LEAD EXTENSION LGW ADVANCED NEUROMODULATION SYSTEMS 3342 64618

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention