BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EON MINI

    MDR report key: 2772015 · Received October 2, 2012

    Report

    Report Number
    1627487-2012-02403
    Event Type
    Injury
    Date Received
    October 2, 2012
    Date of Event
    September 5, 2012
    Report Date
    September 5, 2012
    Manufacturer
    ST. JUDE MEDICAL - NEUROMODULATION
    Product Code
    LGW
    PMA / PMN Number
    P010032
    Removal / Correction Number
    1627487-07262012-002-R
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THIS IPG SERIAL NUMBER WAS INCLUDED IN A FIELD ADVISORY. 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

    DEVICE 1 OF 2. REFERENCE MFR REPORT: 1627487-2012-02404. IT WAS REPORTED, THE PATIENT SUDDENLY LOST STIMULATION. SHE REPORTED WHEN SHE TRIED TO RESTART HER SYSTEM, SHE FELT A JOLT IN HER RIBS AND HER STIMULATION SHUT BACK DOWN. SHE STATED, SHE HAD RECENTLY RECHARGED HER IPG WITHOUT INCIDENT. NO FURTHER INFORMATION IS AVAILABLE AT THIS TIME AS ATTEMPTS TO FOLLOW UP WITH THE PATIENT HAVE BEEN UNSUCCESSFUL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EON MINI SCS IPG LGW ST. JUDE MEDICAL - NEUROMODULATION 3788 3434577

    Patients

    Seq Age Sex Outcome Treatment
    1 41 YR Required Intervention