BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PENTA 60-CM LENGTH PADDLE LEAD

    MDR report key: 2160629 · Received July 6, 2011

    Report

    Report Number
    1627487-2011-03215
    Event Type
    Injury
    Date Received
    July 6, 2011
    Date of Event
    June 7, 2011
    Report Date
    June 7, 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
    OTHER

    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 A SCS SYSTEM ON (B)(6) 2011. IT WAS REPORTED THAT THE PATIENT WAS HAVING A DECOMPRESSION SURGERY AND THE DOCTOR NOTICED THE INSULATION ON THE LEAD WAS COMPROMISED POSSIBLY BY A BOVIE KNIFE. THE LEAD WAS REPLACED. NO FURTHER INFORMATION IS AVAILABLE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PENTA 60-CM LENGTH PADDLE LEAD SPINAL CORD STIMULATION LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3228 3260894

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Required Intervention IMPLANT:| SCS IPG: MODEL 3788