BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LAMITRODE S8

    MDR report key: 2875222 · Received December 13, 2012

    Report

    Report Number
    1627487-2012-15045
    Event Type
    Injury
    Date Received
    December 13, 2012
    Date of Event
    November 20, 2012
    Report Date
    November 20, 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 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

    IT WAS REPORTED, THE PATIENT LOST STIMULATION AFTER A FALL. FOLLOW-UP INDICATED THE LEAD WAS REPOSITIONED. WHEN STIMULATION WAS POSTOPERATIVELY TURNED ON THE PATIENT REPORTED ABDOMINAL PAIN. X-RAYS REVEALED NO ANOMALIES. THE PATIENT'S PHYSICIAN SUSPECTS PAIN WILL SUBSIDE. THE PATIENT IS NOW RECEIVING STIMULATION IN THE PROPER LOCATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LAMITRODE S8 SCS LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3286 3473594

    Patients

    Seq Age Sex Outcome Treatment
    1 34 YR Required Intervention SCS EXTENSION: MODEL 3383| IMPLANT DATE:| IMPLANT DATE:| IMPLANT DATE:| SCS IPG: MODEL 3788| SCS ANCHOR, MODEL 1192