BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LAMITRODE TRIPOLE 16

    MDR report key: 2971030 · Received February 15, 2013

    Report

    Report Number
    1627487-2013-15214
    Event Type
    Injury
    Date Received
    February 15, 2013
    Date of Event
    January 23, 2013
    Report Date
    January 23, 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 2. REF MFR REPORT: 1627487-2013-15213. IT WAS REPORTED THE PT EXPERIENCED SHOCKS IN HER RIBS WITH STIMULATION BOTH ON AND OFF. THE PT INDICATES SHE HAS NOT USED OR CHARGED HER IPG IN OVER A YR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    69576 LAMITRODE TRIPOLE 16 SCS LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3219 2886922

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Required Intervention