BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MEDTRONICS INTERSTIM DEVICE

    MDR report key: 2192672 · Received August 2, 2011

    Report

    Report Number
    MW5021598
    Event Type
    Injury
    Date Received
    August 2, 2011
    Date of Event
    July 22, 2004
    Report Date
    July 24, 2011
    Manufacturer
    MEDTRONICS, INC.
    Product Code
    EZW
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    SEVERE SHOCKING, NERVE PAIN, INFECTION, INVOLUNTARY MOVEMENT OF LEGS, FEET AND TOES. SAME PT AS MW5021599 AND MW5021600.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDTRONICS INTERSTIM DEVICE INTERSTIM DEVICE EZW MEDTRONICS, INC. 3023

    Patients

    Seq Age Sex Outcome Treatment
    1 40 YR Hospitalization| R