BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RENEW SINGLE RECEIVER, 8 CHANNEL

    MDR report key: 2212604 · Received August 11, 2011

    Report

    Report Number
    1627487-2011-04025
    Event Type
    Injury
    Date Received
    August 11, 2011
    Date of Event
    July 15, 2011
    Report Date
    July 15, 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 INFO RELATED TO THE PT'S MEDICAL HISTORY AND IS UNABLE TO FORM AN OPINION AS TO THE RELEVANCY OF THE PT'S HISTORY TO THE EVENT REPORTED. SJM DEFERS TO THE PT'S PHYSICIAN REGARDING MEDICAL HISTORY.

    Description of Event or Problem · 1

    THE PT RECEIVED HIS SCS SYSTEM ON (B)(6) 2007. IT WAS REPORTED THAT THE PT NO LONGER HAD STIMULATION. THE PT RECEIVED A NEW TRANSMITTER, WITH NO SUCCESS. F/U ON THE PT REVEALED THE PT IS SCHEDULED FOR AN EXPLANT. NO FURTHER INFO IS AVAILABLE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RENEW SINGLE RECEIVER, 8 CHANNEL SPINAL CORD STIMULATION RECEIVER LGW ST. JUDE MEDICAL - NEUROMODULATION 3408 65459

    Patients

    Seq Age Sex Outcome Treatment
    1 81 YR Required Intervention SCS LEAD: MODEL 3264| IMPLANT: