BEUDAMED
    FDA Adverse Event Injury Summary report: N

    QUATTRODE

    MDR report key: 2980071 · Received February 22, 2013

    Report

    Report Number
    1627487-2013-03263
    Event Type
    Injury
    Date Received
    February 22, 2013
    Date of Event
    June 26, 2012
    Report Date
    January 28, 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 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 3 OF 3. REF MFR REPORTS: 1627487-2013-03261 & 1627487-2013-03262.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    77620 QUATTRODE SCS LEAD LGW ST JUDE MEDICAL - NEUROMODULATION 3146 3504604

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention IMPLANT DATE:| SCS ANCHOR: MODEL 1192 (3)| SCS EXTENSION: MODEL 3342| IMPLANT DATE:| IMPLANT DATE:| SCS IPG: MODEL 3788