BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EON

    MDR report key: 2903189 · Received January 2, 2013

    Report

    Report Number
    1627487-2013-00014
    Event Type
    Injury
    Date Received
    January 2, 2013
    Date of Event
    August 5, 2009
    Report Date
    December 7, 2012
    Manufacturer
    ST. JUDE MEDICAL NEUROMODULATION
    Product Code
    LGW
    PMA / PMN Number
    P010032
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    SJM HAS LIMITED INFO 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 THE PATIENT'S ((B)(6)) IPG WAS EXPLANTED AND REPLACED. THIS INFO WAS DISCOVERED BY THE MFR AFTER REVIEWING THE PT'S BILLING RECORDS. THE REASON FOR THE PROCEDURE IS UNK. NO FURTHER INFO IS AVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1348 EON SCS IPG LGW ST. JUDE MEDICAL NEUROMODULATION 3716 68515

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK Required Intervention