FDA Adverse Event Injury Summary report: N

SYNCHROMED II

MDR report key: 2853018 · Received November 30, 2012

Report

Report Number
3004209178-2012-10989
Event Type
Injury
Date Received
November 30, 2012
Report Date
October 31, 2012
Manufacturer
MDT PUERTO RICO OPERATIONS CO
Product Code
LKK
PMA / PMN Number
P860004
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
AL, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

(B)(4).

Additional Manufacturer Narrative · 1

PRODUCT ID 8709SC, SERIAL# (B)(4), EXPLANTED: (B)(6) 2012, PRODUCT TYPE CATHETER; PRODUCT ID 8703, LOT# J90070744 EXPLANTED: (B)(6) 2012, PRODUCT TYPE CATHETER; PRODUCT ID 8596SC, SERIAL# (B)(4), EXPLANTED: (B)(6) 2012, PRODUCT TYPE CATHETER. (B)(4). FINAL ANALYSIS OF THE PUMP FOUND NO PUMP ANOMALY. FINAL ANALYSIS OF THE CATHETER DEVICES RETURNED FOUND ACCEPTABLE TESTING, HOWEVER THE CATHETER DEVICES WERE RETURNED INCOMPLETE IN SEGMENTS.

Description of Event or Problem · 1

ADDITIONAL INFORMATION RECEIVED REPORTED THERE WAS A CATHETER INFECTION AND A YEAST INFECTION IN THE PUMP AREA. THE PATIENT RESOLVED WITHOUT SEQUELA ON (B)(6)-2012. THE INFECTION STARTED RIGHT AFTER A PUMP REPLACEMENT IN (B)(6)-2012. IT WAS REPORTED THE BATTERY ¿WENT BAD.¿

Description of Event or Problem · 1

IT WAS REPORTED THAT THE PUMP AND CATHETER WERE REMOVED DUE TO INFECTION. THE PUMP SYSTEM WAS EXPLANTED ON (B)(6) 2012. THE MEDICATION IN THE PUMP WAS DILAUDID. NO OTHER INFORMATION WAS PROVIDED REGARDING THE INFECTION EVENT. ADDITIONAL INFORMATION HAS BEEN REQUESTED, BUT WAS NOT AVAILABLE AS OF THE DATE OF THIS REPORT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SYNCHROMED II PUMP, INFUSION, IMPLANTED, PROGRAMMABLE LKK MDT PUERTO RICO OPERATIONS CO 8637-40

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention