BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OCTRODE

    MDR report key: 3052185 · Received April 4, 2013

    Report

    Report Number
    1627487-2013-04408
    Event Type
    Injury
    Date Received
    April 4, 2013
    Date of Event
    January 25, 2013
    Report Date
    March 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 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

    DEVICE 2 OF 2. REFERENCE MFR REPORT: 1627487-2013-04407. IT WAS REPORTED THE PATIENT HAD FELT A TWISTING RESULTED IN A CHANGE IN THE STIMULATION. AN X-RAY WAS TAKEN WHICH REVEALED THE LEAD HAD MIGRATED DOWNWARD ONE VERTEBRAL BODY. THE SJM REPRESENTATIVE ATTEMPTED REPROGRAMMING, BUT WAS UNABLE TO PROVIDE THE SAME STIMULATION THE PATIENT HAD PREVIOUSLY. IT WAS REPORTED THE PHYSICIAN PLANNED SURGICAL INTERVENTION AT A FUTURE DATE TO ADDRESS THE ISSUE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    139557 OCTRODE SCS LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3186 3778261

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Required Intervention SCS IPG, MODEL 3788| IMPLANT DATE:| SCS ANCHOR, MODEL 1192 (2)| IMPLANT DATE: