BEUDAMED
    FDA Adverse Event Injury Summary report: N

    QUATTRODE LEAD, 3/6 MM, 30 CM

    MDR report key: 2251532 · Received September 14, 2011

    Report

    Report Number
    1627487-2011-06107
    Event Type
    Injury
    Date Received
    September 14, 2011
    Date of Event
    June 2, 2011
    Report Date
    August 16, 2011
    Manufacturer
    ST JUDE MEDICAL - NEUROMODULATION
    Product Code
    LGW
    PMA / PMN Number
    P010032
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AS
    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

    DEVICE 2 OF 6. REF MFR REPORT#S 1627487-2011-01696, 1627487-2011-06108, 1627487-2011-06109 AND 1627487-2011-06110.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 QUATTRODE LEAD, 3/6 MM, 30 CM SPINAL CORD STIMULATION LEAD LGW ST JUDE MEDICAL - NEUROMODULATION 3153 2798889

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention SCS LEAD ANCHOR: MODEL 1194| IMPLANTED: