BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EON MINI

    MDR report key: 2843427 · Received November 15, 2012

    Report

    Report Number
    1627487-2012-12512
    Event Type
    Injury
    Date Received
    November 15, 2012
    Date of Event
    October 26, 2012
    Report Date
    October 26, 2012
    Manufacturer
    ST. JUDE MEDICLA - 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 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 1 OF 2. REFERENCE MFR REPORT #1627487-2012-12501. IT WAS REPORTED THE PT EXPERIENCED LOSS OF STIMULATION IN THE RIGHT SIDE SUBSEQUENT TO A FALL. THE PHYSICIAN REVIEWED IMAGES AND LEADS WERE IN THE CORRECT LOCATION BUT THE LEAD APPEARS TO HAVE PARTIALLY PULLED OUT OF THE IPG. REPORTEDLY THE PT WILL CONSULT WITH THE SURGEON CONCERNING A REVISION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EON MINI SCS IPG LGW ST. JUDE MEDICLA - NEUROMODULATION 3788 3664756

    Patients

    Seq Age Sex Outcome Treatment
    1 51 YR Required Intervention SCS EXT: MODEL 3383(2)| IMPLANT DATE: