BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OCTRODE LEAD

    MDR report key: 2121019 · Received June 9, 2011

    Report

    Report Number
    1627487-2011-02814
    Event Type
    Injury
    Date Received
    June 9, 2011
    Date of Event
    May 11, 2011
    Report Date
    May 11, 2011
    Manufacturer
    ST. JUDE MEDICAL - NEUROMODULATION
    Product Code
    LGW
    PMA / PMN Number
    P010032
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    SJM HAS LIMITED INFORMATION RELATED TO THE PATIENT'S MEDICAL HISTORY AND IS UNABLE TO FORM AN OPINION AS TO THE RELEVANCY OF THE PATIENT'S HISTORY TO THE EVENT REPORTED. SJM DEFERS TO THE PATIENT'S PHYSICIAN REGARDING MEDICAL HISTORY.

    Description of Event or Problem · 1

    THE PATIENT RECEIVED HER SCS SYSTEM, INCLUDING A PERCUTANEOUS LEAD, ON (B)(6) 2009. IT WAS REPORTED THAT THE PATIENT WAS FEELING STIMULATION IN HER LEFT RIBS AND FLANK. DIAGNOSTIC TESTS REVEALED INVALID IMPEDANCES IN LEAD CONTACTS. AN X-RAY SHOWED THAT THE LEAD HAD MIGRATED. THE PHYSICIAN PLANS TO REVISE THE PATIENT'S LEAD; HOWEVER, THE SURGERY DATE IS CURRENTLY UNDETERMINED. NO ADDITIONAL INFORMATION IS AVAILABLE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 OCTRODE LEAD SPINAL CORD STIMULATION LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3186 2847760

    Patients

    Seq Age Sex Outcome Treatment
    1 41 YR Required Intervention IMPLANT:| IMPLANT:| SCS IPG: MODEL 3788| SCS LEAD: MODEL 3163