FDA Adverse Event Malfunction Summary report: N

SYNERGY

MDR report key: 2780175 · Received October 10, 2012

Report

Report Number
3007566237-2012-02428
Event Type
Malfunction
Date Received
October 10, 2012
Report Date
September 11, 2012
Manufacturer
MEDTRONIC MED REL MEDTRONIC PUERTO RICO
Product Code
LGW
PMA / PMN Number
P840001
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MN, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

PRODUCT ID: 748925, SERIAL# (B)(4), IMPLANTED: (B)(6) 2003, PRODUCT TYPE: EXTENSION. PRODUCT ID: 748925, SERIAL# (B)(4), IMPLANTED: (B)(6) 2003, PRODUCT TYPE: EXTENSION. PRODUCT ID: 7435, SERIAL# (B)(4), IMPLANTED: (B)(6) 2003, PRODUCT TYPE: PROGRAMMER. PATIENT PRODUCT ID: 389133, LOT# J0348996V, IMPLANTED: (B)(6) 2003, PRODUCT TYPE: LEAD. PRODUCT ID: 389133, LOT# J0348996V, IMPLANTED: (B)(6) 2003, PRODUCT TYPE: LEAD. (B)(6). (B)(4).

Additional Manufacturer Narrative · 1

(B)(4).

Description of Event or Problem · 1

ADDITIONAL INFORMATION WAS RECEIVED THAT INDICATED THE PATIENT WAS MISTAKEN REGARDING THE DATE OF HIS DEVICE IMPLANT. THE DEVICE HAD BEEN IMPLANTED APPROXIMATELY THREE YEARS AGO AND THEREFORE THE END OF LIFE (EOL) STATUS OF THE BATTERY WAS CONSIDERED NORMAL BATTERY DEPLETION. THE PATIENT RECEIVED A BATTERY REPLACEMENT ON 2012-(B)(6). THE PATIENT HAD RETURN OF GOOD STIMULATION AND RECOVERED WITHOUT SEQUELAE. THE PATIENT WAS SATISFIED WITH THE THERAPEUTIC EFFECT OF THE NEW BATTERY. IF ADDITIONAL INFORMATION IS RECEIVED, A FOLLOW UP REPORT WILL BE SENT.

Description of Event or Problem · 1

IT WAS REPORTED THAT END OF LIFE OF THE DEVICE WAS 10 MONTHS, BUT THE LONGEVITY PREDICTION WAS 20 MONTHS AT THE PATIENT'S STIMULATION SETTINGS. THE PATIENT WAS RECEIVING GREAT AND CONSISTENT THERAPY. 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 SYNERGY STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF LGW MEDTRONIC MED REL MEDTRONIC PUERTO RICO 7427

Patients

Seq Age Sex Outcome Treatment
1