BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OCTRODE

    MDR report key: 2861064 · Received December 3, 2012

    Report

    Report Number
    1627487-2012-02747
    Event Type
    Injury
    Date Received
    December 3, 2012
    Date of Event
    November 6, 2012
    Report Date
    November 7, 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

    IT WAS REPORTED, ONE OF THE PT'S LEADS WAS THOUGHT TO BE PRESSING ON A NERVE AND CAUSING HER DISCOMFORT. THE PHYSICIAN DECIDED TO EXPLANT AND REPLACE THE LEAD WITH A DIFFERENT MODEL. POSTOPERATIVE, THE PT REPORTED EFFECTIVE COVERAGE WITHOUT ANY DISCOMFORT AT THE LEAD SITE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 OCTRODE SCS LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3181 3187185

    Patients

    Seq Age Sex Outcome Treatment
    1 28 YR Required Intervention IMPLANT DATE:| SCS IPG: MODEL 3716| IMPLANT DATE:| SCS LEAD: MODEL 3181| IMPLANT DATE:| SCS ANCHOR: MODEL 1192 (2)