BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OCTRODE

    MDR report key: 2940702 · Received January 29, 2013

    Report

    Report Number
    1627487-2013-13132
    Event Type
    Injury
    Date Received
    January 29, 2013
    Date of Event
    January 8, 2013
    Report Date
    January 8, 2013
    Manufacturer
    ST. JUDE MEDICAL - NEUROMODULATION
    Product Code
    LGW
    PMA / PMN Number
    P010032
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    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

    DEVICE 2 OF 3. REFERENCE MFR REPORT: 1627487-2013-13131 AND 13133. IT WAS REPORTED THE PT'S SCS SYSTEM WAS EXPLANTED DUE TO THE PT BEING DISSATISFIED WITH THE RESULTS HER SYSTEM WAS PROVIDING. THE PT STATED THE STIMULATION HAD MADE HER PAIN WORSE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    39073 OCTRODE SCS LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3189 3622343

    Patients

    Seq Age Sex Outcome Treatment
    1 39 YR Required Intervention