BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EON PATIENT PROGRAMMER

    MDR report key: 2792248 · Received October 10, 2012

    Report

    Report Number
    1627487-2012-12248
    Event Type
    Injury
    Date Received
    October 10, 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 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

    IT WAS REPORTED FOLLOWING WALKING THROUGH AIRPORT SECURITY, THE PROBLEM '-' BUTTON INCREASE STIMULATION. THE SJM REP MET WITH THE PT TO INTERROGATE THE PROGRAMMER. THE PROGRAMMER PERFORMED AS DESIGNED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EON PATIENT PROGRAMMER SCS PROGRAMMER LGW ST. JUDE MEDICAL - NEUROMODULATION 3851 3556888

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR Required Intervention IMPLANT:| SCS IPG: MODEL 3688| IMPLANT:| SCS LEAD: MODEL 3186 (2)