BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OCTRODE

    MDR report key: 3052822 · Received April 2, 2013

    Report

    Report Number
    1627487-2013-12431
    Event Type
    Injury
    Date Received
    April 2, 2013
    Date of Event
    September 1, 2012
    Report Date
    March 8, 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. REF MFR REPORT #1627487-2013-12430. IT WAS REPORTED THE PT EXPERIENCED INCREASED STIMULATION WITHOUT PROMPTING AND WAS UNABLE TO ADJUST THE STIMULATION USING THE PROGRAMMER. THE PHYSICIAN PLANS TO EXPLANT THE SYSTEM DUE TO THE NEED FOR AN MRI.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    134321 OCTRODE SCS LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3286 3467812

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR Required Intervention IMPLANT DATE:| SCS IPG, MODEL 3788| SCS ANCHORS, MODEL 11192 (2)| IMPLANT DATE: