BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OCTRODE

    MDR report key: 2792054 · Received October 12, 2012

    Report

    Report Number
    1627487-2012-11479
    Event Type
    Injury
    Date Received
    October 12, 2012
    Date of Event
    April 3, 2012
    Report Date
    September 19, 2012
    Manufacturer
    ST. JUDE MEDICAL - NEUROMODULATION
    Product Code
    LGW
    PMA / PMN Number
    P010032
    Adverse Event
    Yes
    Product Problem
    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

    DEVICE 2 OF 2. REFERENCE MFR REPORT: 1627487-2012-11478. IT WAS REPORTED THE PT WAS EXPERIENCING SHOCKING SENSATIONS RANDOMLY NEAR THE LEADS. THE SJM REPRESENTATIVE MET WITH THE PT AND DETERMINED THE LEAD HAD LOW IMPEDANCES. THE PT REPORTED SHE HAD LOW BACK COVERAGE, BUT A FEW WEEKS AFTER IMPLANT SHE NO LONGER HAD COVERAGE OF THE AREA. IT WAS REPORTED THE PHYSICIAN PLANNED SURGICAL INTERVENTION TO ADDRESS THE ISSUE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 OCTRODE SCS LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3186 3536583

    Patients

    Seq Age Sex Outcome Treatment
    1 32 YR Required Intervention IMPLANTED:| SCS IPG: MODEL 3788| IMPLANTED:| SCS ANCHOR: MODEL 1192 (2)