BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LAMITRODE 88C

    MDR report key: 2792086 · Received October 11, 2012

    Report

    Report Number
    1627487-2012-12250
    Event Type
    Injury
    Date Received
    October 11, 2012
    Date of Event
    September 18, 2012
    Report Date
    September 18, 2012
    Manufacturer
    ST. JUDE MEDICAL - NEUROMODULATION
    Product Code
    LGW
    PMA / PMN Number
    P010032
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    SJM HAS LIMITED INFORMATION 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 4. REFERENCE MFR REPORT #1627487-2012-12249, 12251, 12252. IT WAS REPORTED SCS SYSTEM WAS EXPLANTED DUE TO AN INFECTION AT THE LEAD SITE. THE PT WAS GIVEN INTRAVENOUS ANTIBIOTICS IN THE HOSPITAL. F/U DETERMINED THE PT WAS RELEASED FROM THE HOSPITAL AND IS TAKING ORAL ANTIBIOTICS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LAMITRODE 88C SCS LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3289 3440601

    Patients

    Seq Age Sex Outcome Treatment
    1 41 YR Hospitalization| R