BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EON MINI

    MDR report key: 2960931 · Received February 11, 2013

    Report

    Report Number
    1627487-2013-05189
    Event Type
    Injury
    Date Received
    February 11, 2013
    Date of Event
    January 10, 2013
    Report Date
    January 17, 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 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

    DEVICE 2 OF 2. REFERENCE MFR. REPORT#: 1627487-2013-05188. THE PATIENT HAS TWO LEADS (FROM THE SAME LOT). IT WAS REPORTED THE PATIENT HAD FALLEN. SINCE FALLING THE PATIENT HAS EXPERIENCED OVERSTIMULATION THAT LEADS TO PAIN AT THE IPG SITE AND DOWN HER LEGS. A DIAGNOSTIC CHECK REVEALED HIGH IMPEDANCE. THE PATIENT WILL UNDERGO SURGICAL INTERVENTION TO ADDRESS THE ISSUE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    60088 EON MINI SCS IPG LGW ST. JUDE MEDICAL - NEUROMODULATION 3788 3721985

    Patients

    Seq Age Sex Outcome Treatment
    1 61 YR Required Intervention IMPLANT:| SCS ANCHORS: MODEL 1192 (X2)