BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OCTRODE

    MDR report key: 2831899 · Received November 9, 2012

    Report

    Report Number
    1627487-2012-02654
    Event Type
    Injury
    Date Received
    November 9, 2012
    Date of Event
    October 18, 2012
    Report Date
    October 18, 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 INFORMATION RELATED TO THE PATIENT'S MEDICAL HISTORY AND IS UNABLE TO FORM AN OPINION AS TO THE RELEVANCY OF THE PATIENT'S HISTORY TO THE EVENT REPORTED. SJM DEFERS TO THE PATIENT'S PHYSICIAN REGARDING MEDICAL HISTORY.

    Description of Event or Problem · 1

    DEVICE 1 OF 2. REFERENCE MFR REPORT: 1627487-2012-02655. IT WAS REPORTED, THE PATIENT LOST STIMULATION AND HAS A LOSS OF PERCEPTION AT 0.5 MA. DIAGNOSTIC TESTS REVEAL INVALID IMPEDANCE READINGS ACROSS MULTIPLE LEAD CONTACTS. IT WAS REPORTED SURGICAL INTERVENTION WOULD BE UNDERTAKEN TO ADDRESS THE ISSUE. NO FURTHER INFORMATION IS AVAILABLE AT THIS TIME. ACCORDING TO THE MANUFACTURER'S DEVICE REGISTRATION SYSTEM, THE LEADS WERE REPLACED ON (B)(6) 2012.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 OCTRODE SCS LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3186 2864865

    Patients

    Seq Age Sex Outcome Treatment
    1 61 YR Required Intervention SCS IPG, MODEL 3788| IMPLANT DATE:| IMPLANT DATE:| SCS ANCHOR, MODEL 1192