BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EON

    MDR report key: 3110594 · Received May 10, 2013

    Report

    Report Number
    1627487-2013-06274
    Event Type
    Injury
    Date Received
    May 10, 2013
    Date of Event
    April 16, 2013
    Report Date
    April 16, 2013
    Manufacturer
    ST. JUDE MEDICAL, NEUROMODULATION DIVISION
    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

    IT WAS REPORTED THE PATIENT WAS EXPERIENCING DISCOMFORT AT THE IPG POCKET SITE. THE IPG WAS REPLACED WITH A NEW AND SMALLER MODEL. THE NEW IPG WAS IMPLANTED AT A NEW POCKET LOCATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    208526 EON SCS IPG LGW ST. JUDE MEDICAL, NEUROMODULATION DIVISION 3716 174669

    Patients

    Seq Age Sex Outcome Treatment
    1 58 YR Required Intervention SCS LEAD: MODEL 3219| IMPLANT DATE: