BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OCTRODE

    MDR report key: 3010631 · Received March 14, 2013

    Report

    Report Number
    1627487-2013-02376
    Event Type
    Injury
    Date Received
    March 14, 2013
    Date of Event
    February 22, 2013
    Report Date
    February 22, 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 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

    IT WAS REPORTED THE PATIENT'S LEAD WAS NO LONGER PROVIDING EFFECTIVE STIMULATION COVERAGE AND DISPLAYED HIGH IMPEDANCE READINGS. THE PHYSICIAN DECIDED TO EXPLANT AND REPLACE THE LEAD WITH TWO DIFFERENT MODEL LEADS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    108306 OCTRODE SCS LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3186 3486364

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR Required Intervention IMPLANT DATE:| SCS IPG: MODEL 3688| SCS LEAD: MODEL 3166 (2)| IMPLANT DATE: