FDA Adverse Event Injury Summary report: N

SYNCHROMED

MDR report key: 3111397 · Received May 14, 2013

Report

Report Number
3007566237-2013-01608
Event Type
Injury
Date Received
May 14, 2013
Report Date
April 16, 2013
Manufacturer
MEDTRONIC NEUROMODULATION
Product Code
LKK
PMA / PMN Number
P860004
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
FR
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

PRODUCT ID 8731SC, LOT # UNKNOWN, EXPLANTED: (B)(6) 2013, PRODUCT TYPE CATHETER. (B)(4).

Additional Manufacturer Narrative · 1

ANALYSIS OF THE CATHETER AND SC CONNECTOR REVEALED INDENT IN SEAL AND OCCLUSION RELATED ISSUE. DURING PATENCY TESTING, OCCLUSION OCCURRED INTERMITTENTLY. UNDER MICROSCOPE INSPECTION CIRCULAR CORING CAN BE SEEN IN THE BOTTOM OF THE CUP OF THE SC CONNECTOR CONSISTENT WITH THE INNER DIAMETER OF THE TIP OF THE OUTLET PORT OF THE PUMP. A MAJORITY OF THE CORING AREAS IS LOCATED IN THE SEAL MATERIAL OF THE CUP OF THE SC CONNECTOR. IT IS THOUGHT THE SC CONNECTION TO THE PUMP WAS INITIALLY PATENT BUT AS CORING OCCURRED, THE FLAP OF MATERIAL THAT WAS CREATED BEGAN TO CAUSE AN OCCLUSION.

Description of Event or Problem · 1

THE CATHETER WAS EXPLANTED ON (B)(6) 2013. THE PATIENT STATUS WAS ALIVE, NO INJURY, NO ADVERSE EVENT. THE PUMP WAS DELIVERING LIORESAL.

Description of Event or Problem · 1

IT WAS REPORTED THE CATHETER WAS EXPLANTED FOLLOWING SUSPICION OF OCCLUSION, "TWO OR THREE" MONTHS AGO. THE CATHETER AND PUMP WERE IMPLANTED "SEVEN OR EIGHT" MONTHS AGO. THE CATHETER WAS SAID TO BE "CAPPED/ABANDONED/PARTIALLY REMOVED." THE PATIENT HAD SYMPTOMS OF INCREASED SPASTICITY.

Description of Event or Problem · 1

FOLLOWING THE CATHETER REPLACEMENT, THE PATIENT WAS ¿OK¿ AND RECEIVING EFFECTIVE THERAPY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
212566 SYNCHROMED PUMP, INFUSION, IMPLANTED, PROGRAMMABLE LKK MEDTRONIC NEUROMODULATION NEU_UNKNOWN_PUMP

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention