FDA Adverse Event Injury Summary report: N

SYNCHROMED II

MDR report key: 2113708 · Received June 2, 2011

Report

Report Number
3004209178-2011-03938
Event Type
Injury
Date Received
June 2, 2011
Date of Event
January 1, 2011
Report Date
May 2, 2011
Manufacturer
MDT PUERTO RICO OPERATIONS CO., JUNCOS
Product Code
LKK
PMA / PMN Number
P860004
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
NV, US
Reporter Occupation
NOT APPLICABLE

Narratives

Additional Manufacturer Narrative · 1

(B)(4).

Additional Manufacturer Narrative · 1

(B)(4).

Description of Event or Problem · 1

IT WAS REPORTED THAT THE PT'S CATHETER HAD COMPLICATIONS. THE CATHETER WAS NOT IMPLANTED CORRECTLY INTO THE INTRATHECAL SPACE. THE PT WAS ALWAYS PROGRAMMED AT THE HIGHEST DOSAGE OF MEDICATION AND WAS "POISONED BY THE MEDICATION" BECAUSE IT WAS NOT GOING INTO THE INTRATHECAL SPACE. THE PT'S PUMP AND CATHETER WERE REMOVED. THE DRUG IN THE PUMP AT THE TIME OF THE EVENT WAS UNK. ADDITIONAL INFO HAS BEEN REQUESTED; A FOLLOW-UP REPORT WILL BE SUBMITTED IF ADDITIONAL INFO BECOMES AVAILABLE.

Description of Event or Problem · 1

ADDITIONAL INFORMATION: IT WAS REPORTED THAT THE PATIENT HAD "5 MEDS GOING THROUGH THE PUMP AND HAD IT ON THE HIGHEST SETTINGS" BUT IT DID NOT HELP HER PAIN. SPECIFIC MEDICATIONS WERE NOT PROVIDED. THE PATIENT HAD THE PHYSICIAN LOOK INTO IT AND STATED THAT THE PHYSICIAN DID NOT PROPERLY INSTALL THE CATHETER. AFTER THE PUMP AND CATHETER WERE EXPLANTED THE PATIENT HAD A DIFFERENT DEVICE IMPLANTED AND HAS HAD NO ISSUES.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SYNCHROMED II PUMP, INFUSION, IMPLANTED, PROGRAMMABLE LKK MDT PUERTO RICO OPERATIONS CO., JUNCOS 863740 NA

Patients

Seq Age Sex Outcome Treatment
1 43 YR Required Intervention IMPLANTED:| EXPLANTED:| CATHETER: MODEL 8709, LOT: N073959030