FDA Adverse Event Injury Summary report: N

SYNERGY

MDR report key: 2892123 · Received January 2, 2013

Report

Report Number
3004209178-2013-00009
Event Type
Injury
Date Received
January 2, 2013
Report Date
December 10, 2012
Manufacturer
MEDTRONIC MED REL MEDTRONIC PUERTO RICO
Product Code
LGW
PMA / PMN Number
P840001
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
MN, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

PRODUCT ID, 7496-51 LOT# SERIAL# (B)(4), IMPLANTED: 1996 (B)(6), PRODUCT TYPE EXTENSION PRODUCT ID, 7435 LOT# SERIAL# (B)(4), PRODUCT TYPE PROGRAMMER, PATIENT PRODUCT ID 3982 LOT# SERIAL# (B)(4), IMPLANTED: 1996 (B)(6), PRODUCT TYPE LEAD PRODUCT ID 3550-09 LOT# N220024, IMPLANTED: 2011 (B)(6), PRODUCT TYPE ACCESSORY. (B)(4).

Description of Event or Problem · 1

FOLLOW UP INFORMATION RECEIVED REPORTED THAT THE PATIENT HAD REVISION SURGERY ON (B)(6) 2013 AT WHICH TIME THE IMPLANTABLE NEUROSTIMULATOR POCKET WAS MOVED FROM THEIR CHEST WALL TO THE ABDOMEN SO IT WAS NOT SO SUPERFICIAL. FOLLOWING THE SURGERY, THE PATIENT WAS REPORTED AS RECEIVING EFFECTIVE THERAPY. THE PATIENT HAD A FOLLOW UP APPOINTMENT SCHEDULED FOR (B)(6) 2013. IF ADDITIONAL INFORMATION IS RECEIVED, A FOLLOW UP REPORT WILL BE SENT.

Description of Event or Problem · 1

ADDITIONAL INFORMATION RECEIVED REPORTED THAT THE PATIENT WAS CURRENTLY BEING TREATED ON ORAL MEDICATIONS. THE REPORTER STATED THAT THE PATIENT'S SURGERY DATE HAD BEEN PUSHED BACK TO (B)(6)-2013. A FOLLOW-UP REPORT WILL BE MADE IF ADDITIONAL INFORMATION BECOMES AVAILABLE.

Description of Event or Problem · 1

ADDITIONAL INFORMATION RECEIVED REPORTED THE PATIENT'S SURGERY WAS CANCELLED AND MOVED TO (B)(6) 2013. A FOLLOW-UP REPORT WILL BE MADE IF ADDITIONAL INFORMATION BECOMES AVAILABLE.

Description of Event or Problem · 1

ADDITIONAL INFORMATION RECEIVED REPORTED THE INFECTION SITE LOOKED '10 TIMES" BETTER AND THE NEW POCKET SITE LOOKED 'GREAT.' THE PATIENT WAS FEELING GREAT AND WAS NO LONGER ON ORAL MEDICATIONS. THE PATIENT'S NEXT APPOINTMENT WAS FOR (B)(6) 2013. THE PATIENT WAS RECEIVING 'GREAT' THERAPY, AND THERE WAS NO SIGN OF INFECTION.

Description of Event or Problem · 1

IT WAS REPORTED, THERE WAS AN INFECTION. IT WAS NOTED, THE PATIENT HAD FALLEN AND GOTTEN A SCRAPE WHICH CAUSED THE INFECTION. THE PATIENT HAD BEEN PUS AT THE CHEST SITE SO THEY REMOVED THE BATTERY. THE EXTENSION AND LEAD WERE STILL IN PLACE. FOLLOW UP REPORTED. THE PATIENT WAS SCHEDULED TO HAVE THE EXTENSION AND LEAD REMOVED. IT WAS NOTED THEY WERE UNSURE IF THE FALL WAS HOW THE PATIENT GOT INFECTED, BUT IT WAS KNOWN THERE WAS SOME INCIDENT/INJURY AND WHEN THEY REMOVED THE BATTERY THERE WAS PUS. ADDITIONAL INFORMATION HAS BEEN REQUESTED BUT WAS NOT AVAILABLE AS OF THE DATE OF THIS REPORT; A FOLLOW-UP REPORT WILL BE SENT IF INFORMATION BECOMES AVAILABLE.

Description of Event or Problem · 1

ADDITIONAL INFORMATION RECEIVED REPORTED THE PATIENT HAD BEEN SEEN THE DAY OF THIS REPORT AND THE PATIENT HAD NO INFECTION AND THEIR WOUNDS HAD HEALED GREATLY. THE OLD POCKET LOOKED NORMAL.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1636 SYNERGY STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF LGW MEDTRONIC MED REL MEDTRONIC PUERTO RICO 7427

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention