BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PENTA

    MDR report key: 3032351 · Received March 29, 2013

    Report

    Report Number
    1627487-2013-02448
    Event Type
    Injury
    Date Received
    March 29, 2013
    Date of Event
    March 6, 2013
    Report Date
    March 6, 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 HAD UNINTENDED STIMULATION IN HIS ABDOMEN AND BUTTOCKS. REPROGRAMMING WAS ABLE TO PROVIDE STIMULATION IN HIS LEFT LEG AND BACK WITH LESS ABDOMINAL STIMULATION. IT WAS REPORTED THE PT WOULD FOLLOW-UP WITH THE PHYSICIAN AT A LATER DATE AFTER HE HAD TRIED THE NEW PROGRAMS. NO FURTHER INFORMATION IS AVAILABLE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    131180 PENTA SCS LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3228 3832209

    Patients

    Seq Age Sex Outcome Treatment
    1 30 YR Required Intervention IMPLANT DATE:| SCS IPG: MODEL: 3788