BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PENTA

    MDR report key: 3110703 · Received May 10, 2013

    Report

    Report Number
    1627487-2013-01522
    Event Type
    Injury
    Date Received
    May 10, 2013
    Date of Event
    April 19, 2013
    Report Date
    April 19, 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

    IT WAS REPORTED THE PT IS NOT RECEIVING EFFECTIVE STIMULATION AND IS WANTING HER SCS SYSTEM REMOVED. MULTIPLE REPROGRAMMING ATTEMPTS HAVE BEEN UNABLE TO RESOLVE THE ISSUE. THE PT HAS DECLINED FURTHER REPROGRAMMING. FOLLOW-UP INFORMATION IDENTIFIED THE PT MET WITH HER SURGEON AND THE DECISION WAS MADE TO TRY TURNING OFF THE STIMULATION FOR AWHILE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    208103 PENTA SCS LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3228 3726672

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Required Intervention IMPLANT DATE:| SCS IPG, MODEL 3788