BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OCTRODE 60-CM LENGTH PERCUTANEOUS LEAD

    MDR report key: 2181362 · Received July 21, 2011

    Report

    Report Number
    1627487-2011-04005
    Event Type
    Injury
    Date Received
    July 21, 2011
    Date of Event
    June 22, 2011
    Report Date
    June 22, 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

    PHYSICIAN REPORTEDLY PERFORMED PROCEDURE TO PLACE THE SCS LEAD IN THE PATIENT ON (B)(6) 2011. THE PATIENT REPORTED EXCRUCIATING, INTRAOPERATIVE PAIN. THE PHYSICIAN REMOVED THE LEAD AND NOTICED CEREBROSPINAL FLUID PRESENT. THE PHYSICIAN DECIDED TO ABORT THE IMPLANT WITHOUT A BLOOD PATCH. FACILITY REPORTEDLY DISCARDED THE LEAD. ATTEMPTS TO CONTACT THE PHYSICIAN'S OFFICE FOR ADDITIONAL INFORMATION HAVE BEEN MADE, AND HAVE BEEN UNSUCCESSFUL. NO FURTHER INFORMATION IS AVAILABLE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 OCTRODE 60-CM LENGTH PERCUTANEOUS LEAD SPINAL CORD STIMULATION LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3186 333314

    Patients

    Seq Age Sex Outcome Treatment
    1 64 YR Hospitalization| O| R