BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EON MINI

    MDR report key: 3001519 · Received March 5, 2013

    Report

    Report Number
    1627487-2013-05324
    Event Type
    Injury
    Date Received
    March 5, 2013
    Date of Event
    January 1, 2013
    Report Date
    February 13, 2013
    Manufacturer
    ST. JUDE MEDICAL - NEUROMODULATION
    Product Code
    LGW
    PMA / PMN Number
    P010032
    Adverse Event
    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 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

    IT WAS REPORTED THE PT HAS BEEN EXPERIENCING PAIN AT THE IPG SITE. ANTI-INFLAMMATORY MEDICATION WAS USED TO ADDRESS THE ISSUE, BUT WAS UNSUCCESSFUL. AS A RESULT, THE PT WILL UNDERGO SURGICAL INTERVENTION ON A LATER DATE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    94048 EON MINI SCS IPG LGW ST. JUDE MEDICAL - NEUROMODULATION 3788 3735005

    Patients

    Seq Age Sex Outcome Treatment
    1 41 YR Required Intervention SCS LEADS: MODEL 3186 (X2)| IMPLANT:| IMPLANT:| IMPLANT:| SCS EXTENSIONS: MODEL 3386 (X2)| SCS ANCHORS: MODEL 1192 (X2)