FDA Adverse Event Malfunction Summary report: N

RESTORE

MDR report key: 2992578 · Received March 7, 2013

Report

Report Number
3004209178-2013-03438
Event Type
Malfunction
Date Received
March 7, 2013
Report Date
February 19, 2013
Manufacturer
MEDTRONIC MED REL MEDTRONIC PUERTO RICO
Product Code
LGW
PMA / PMN Number
P840001
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
OH, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

(B)(4).

Additional Manufacturer Narrative · 1

PRODUCT ID 748951, SERIAL # (B)(4), IMPLANTED: (B)(6) 2006, PRODUCT TYPE EXTENSION; PRODUCT ID 748951, SERIAL # (B)(4), IMPLANTED: (B)(6) 2006, PRODUCT TYPE EXTENSION; PRODUCT ID 3998, LOT # J0504327V, IMPLANTED: (B)(6) 2005, PRODUCT TYPE LEAD; PRODUCT ID 37752, SERIAL # (B)(4), PRODUCT TYPE RECHARGER; PRODUCT ID 37743, SERIAL # (B)(4), PRODUCT TYPE PROGRAMMER.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE PATIENT'S DEVICE "HAD NOT WORKED" IN 6 MONTHS AND HE HAD BEEN TRYING TO CHARGE IT SINCE THEN. COUPLING AND/OR COMMUNICATION ISSUES WERE REPORTED. IT WAS SUSPECTED THAT THE IMPLANTABLE NEUROSTIMULATOR (INS) MAY HAVE BEEN FLIPPED BUT WASN'T CONFIRMED AT THE TIME OF THE REPORT. NO FURTHER INFORMATION WAS REPORTED. IF ADDITIONAL INFORMATION BECOMES AVAILABLE, A FOLLOW-UP REPORT WILL BE SUBMITTED.

Description of Event or Problem · 1

IT WAS REPORTED THE PATIENT EXPERIENCED COUPLING AND OR COMMUNICATION ISSUES. IT WAS REPORTED THE PATIENT¿S DEVICE HAD NOT WORKED IN 6 MONTHS AND HE HAD BEEN TRYING TO CHARGE SINCE THEN AND IT WOULD NOT TAKE A CHARGE. IT WAS NOTED THE PATIENT ¿COULD NOT EVEN TURN IT ON¿ AND THAT THE BATTERY WAS DEAD. IT WAS REPORTED THE PATIENT WAS GETTING 0 COUPLING BOXES. IT WAS LOGGED THE DEVICE WAS NOT IN OVERDISCHARGE. IT WAS LOGGED THE INS MAY HAVE BEEN FLIPPED. IT WAS NOTED THE FLIP WAS NOT CONFIRMED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
96756 RESTORE STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF LGW MEDTRONIC MED REL MEDTRONIC PUERTO RICO 37711

Patients

Seq Age Sex Outcome Treatment
1