FDA Adverse Event Injury Summary report: N

SYNCHROMED II

MDR report key: 2772410 · Received October 4, 2012

Report

Report Number
3004209178-2012-08883
Event Type
Injury
Date Received
October 4, 2012
Report Date
September 13, 2012
Manufacturer
MDT PUERTO RICO OPERATIONS CO
Product Code
LKK
PMA / PMN Number
P860004
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MD, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

(B)(4).

Additional Manufacturer Narrative · 1

PRODUCT ID 8709SC, LOT# H825097210, IMPLANTED: 2012 (B)(6), EXPLANTED: 2012 (B)(6), PRODUCT TYPE CATHETER (B)(4).

Description of Event or Problem · 1

IT WAS REPORTED THAT THERE WAS A CATHETER REVISION AND SUBSEQUENTLY AN INFECTION AND PUMP SYSTEM EXPLANT. ON (B)(6) 2012, IT WAS REPORTED THAT PATIENT WAS TAKEN TO THE OPERATING ROOM TO RE-ANCHOR THE CATHETER AT THE BACK CATHETER SITE. THE CAUSE/NEED FOR THE CATHETER ANCHOR REVISION WAS NOT PROVIDED. FOLLOWING THE REVISION, THE PATIENT WAS DISCHARGED WITH NO ISSUES AND WAS DOING WELL UP UNTIL (B)(6) 2012 WHEN THEY DEVELOPED A FEVER OF 103F. BY (B)(6) 2012 THE PATIENT DEVELOPED REDNESS AT THE PUMP POCKET SITE WHICH EXTENDED TO BACK INCISION AREA. PATIENT WAS TAKEN TO THE HOSPITAL AND WAS ADMITTED TO THE NURSING UNIT. THE HEALTHCARE PROVIDER THEN EXPLANTED THE PUMP AND CATHETER ON (B)(6) 2012 DUE TO INFECTION. CULTURES WERE SENT OFF FROM THE PUMP POCKET AND BACK INCISION SITES. THE PATIENT WAS PLACED ON ORAL BACLOFEN 20 MG THREE TIMES A DAY TO SUPPLEMENT PUMP THERAPY. THE PATIENT WAS ADMITTED TO THE NURSING UNIT STABLE FOLLOWING THE EXPLANT SURGERY. THE MEDICATION IN THE PUMP WAS LIORESAL (BACLOFEN). ADDITIONAL INFORMATION HAS BEEN REQUESTED, BUT WAS NOT AVAILABLE AS OF THE DATE OF THIS REPORT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SYNCHROMED II PUMP, INFUSION, IMPLANTED, PROGRAMMABLE LKK MDT PUERTO RICO OPERATIONS CO 8637-20

Patients

Seq Age Sex Outcome Treatment
1 00008 YR Hospitalization| R