FDA Adverse Event Malfunction Summary report: N

ENTERRA

MDR report key: 3002783 · Received March 13, 2013

Report

Report Number
3007566237-2013-00773
Event Type
Malfunction
Date Received
March 13, 2013
Report Date
February 27, 2013
Manufacturer
MEDTRONIC NEUROMODULATION
Product Code
LNQ
PMA / PMN Number
H990014
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
TX, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

(B)(4).

Additional Manufacturer Narrative · 1

(B)(4).

Description of Event or Problem · 1

ADDITIONAL INFORMATION RECEIVED REPORTED THAT THE PATIENT WAS HURTING REALLY BAD FROM THE BURNING/STINGING SENSATION AS REPORTED PREVIOUSLY. THE PATIENT STOPPED EATING BECAUSE HE COULD NOT EAT. THE PATIENT GOT NAUSEATED ALL THE TIME. THE PATIENT WOULD ¿THROW IT ALL UP TO THE POINT OF THROWING UP BLOOD.¿ IT WAS NOTED THAT THE PATIENT ONCE DROPPED 70 POUNDS IN THE COURSE OF FOUR MONTHS. IT WAS ALSO REPORTED THAT THE PATIENT FELT ¿SOMETHING¿S BEEN DISLODGED OR CAME APART.¿

Description of Event or Problem · 1

IT WAS REPORTED THAT 3 WEEKS AGO THE PATIENT WAS SLEEPING, ROLLED OVER, FELT A POP AND THEN A BURNING/STINGING SENSATION STARTED IN THE PATIENT'S STOMACH WHICH LASTED ABOUT 4 HOURS. THE PATIENT FELT LIKE THE DEVICE SHORT CIRCUITED INSIDE OF HER; THE PATIENT FELT SHE WAS GETTING SHOCKED. THE PATIENT'S SYMPTOMS RETURNED 3 WEEKS AGO. PRIOR TO 3 WEEKS AGO THE DEVICE WAS WORKING GREAT. THE PATIENT HAD SOME ABDOMINAL PAIN BUT WAS ABLE TO EAT AND KEEP FOOD DOWN. THE PATIENT WANTED THE DOCTOR TO DO AN XRAY. THE DOCTOR WANTED TO TRY REPROGRAMMING. THE PATIENT WAS SCHEDULED TO BE SEEN IN FOLLOW UP BY THE HEALTH CARE PROFESSIONAL. IF ADDITIONAL INFORMATION IS RECEIVED, A FOLLOW UP REPORT WILL BE SENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
105268 ENTERRA INTESTINAL STIMULATOR LNQ MEDTRONIC NEUROMODULATION NEU_ENTERRA_INS

Patients

Seq Age Sex Outcome Treatment
1