FDA Adverse Event Malfunction Summary report: N

PRIMEADVANCED

MDR report key: 3071257 · Received April 22, 2013

Report

Report Number
3004209178-2013-06669
Event Type
Malfunction
Date Received
April 22, 2013
Report Date
April 5, 2013
Manufacturer
MEDTRONIC MED REL MEDTRONIC PUERTO RICO
Product Code
LGW
PMA / PMN Number
P840001
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
AR, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

(B)(4).

Additional Manufacturer Narrative · 1

CONCOMITANT PRODUCTS: PRODUCT ID 3778-60, SERIAL# (B)(4), IMPLANTED: (B)(6) 2009, PRODUCT TYPE LEAD; PRODUCT ID 3778-60, SERIAL# (B)(4), IMPLANTED: (B)(6) 2009, PRODUCT TYPE LEAD. (B)(4).

Description of Event or Problem · 1

IT WAS REPORTED THE PATIENT SAW AN ELECTIVE REPLACEMENT INDICATOR (ERI) MESSAGE ON THEIR PATIENT PROGRAMMER A FEW MONTHS PRIOR TO REPORT. IT WAS ALSO REPORTED IT WAS UNKNOWN WHAT THE PATIENT'S STIMULATION STATUS WAS AND IF THEIR DEVICE HAD REACHED END OF SERVICE (EOS) YET. FIVE DAYS LATER, IT WAS REPORTED THE PATIENT RECEIVED AN ERI MESSAGE AND THEY STATED THEIR BATTERY HAD BEEN REPLACED JUST "6 MONTHS AGO OR SO". MANUFACTURER RECORDS SHOW THE PATIENT'S DEVICE WAS IMPLANTED NINE MONTHS PRIOR TO REPORT. THE PATIENT WAS REDIRECTED TO THEIR HEALTHCARE PROVIDER.

Description of Event or Problem · 1

ADDITIONAL INFORMATION STATED THE PATIENT ¿RECEIVED ASSISTANCE FROM THEIR DOCTOR OR MANUFACTURER REPRESENTATIVE AND THEIR CONCERNS WERE RESOLVED¿ AND THAT THEY HAD AN APPOINTMENT SCHEDULED FOR (B)(6) 2013. IT WAS ALSO NOTED THE PATIENT ¿STILL HAD CONCERNS WITH THEIR DEVICE OR THERAPY, BUT HAD NOT SOUGHT FURTHER HELP.¿

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
171866 PRIMEADVANCED STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF LGW MEDTRONIC MED REL MEDTRONIC PUERTO RICO 37702

Patients

Seq Age Sex Outcome Treatment
1