BEUDAMED
    FDA Adverse Event Death Summary report: N

    EONC

    MDR report key: 3052201 · Received April 2, 2013

    Report

    Report Number
    1627487-2013-15438
    Event Type
    Death
    Date Received
    April 2, 2013
    Date of Event
    February 5, 2013
    Report Date
    March 11, 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 INFO 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 PT PASSES AWAY ON (B)(6) 2013. THE CAUSE OF DEATH IS CURRENTLY UNK. F/U IS IN PROGRESS TO OBTAIN ADD'L INFO.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    133713 EONC SCS IPG LGW ST JUDE MEDICAL - NEUROMODULATION 3688 3538823

    Patients

    Seq Age Sex Outcome Treatment
    1 82 YR Death SCS ANCHOR: MODEL 1192 (2)| IMPLANT DATE:| IMPLANT DATE:| SCS LEAD: MODEL 3186 (2)