BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OCTRODE

    MDR report key: 2800848 · Received October 18, 2012

    Report

    Report Number
    1627487-2012-02518
    Event Type
    Injury
    Date Received
    October 18, 2012
    Date of Event
    September 24, 2012
    Report Date
    September 24, 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 2. REFERENCE MFR REPORT: 1627487-2012-02517. THE PT UNDERWENT A RADIO FREQUENCY ABLATION PROCEDURE AND IT WAS NOTED THAT ONE OF THE PT'S LEADS HAD MIGRATED OUT OF THE EPIDURAL SPACE. THE PT ALLEGEDLY DOES NOT HAVE STIMULATION. IT WAS REPORTED THE PT WILL SEE HIS PHYSICIAN REGARDING THE NEXT COURSE OF ACTION. BOTH OF THE PT'S SCS LEADS ARE BEING REPORTED AS IT IS CURRENTLY UNKNOWN WHICH LEAD WAS INVOLVED. NO FURTHER INFORMATION IS AVAILABLE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 OCTRODE SCS LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3189 3148149

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR Required Intervention IMPLANT DATE:| SCS ANCHOR: MODEL: 1192| SCS IPG: MODEL: 3788| IMPLANT DATE: