FDA Adverse Event Malfunction Summary report: N

PRIMEADVANCED

MDR report key: 3113560 · Received May 15, 2013

Report

Report Number
3004209178-2013-07692
Event Type
Malfunction
Date Received
May 15, 2013
Report Date
April 15, 2013
Manufacturer
MEDTRONIC MED REL MEDTRONIC PUERTO RICO
Product Code
LGW
PMA / PMN Number
P840001
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MN, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

(B)(4).

Additional Manufacturer Narrative · 1

PRODUCT ID 37744 LOT# SERIAL# (B)(4), PRODUCT TYPE PROGRAMMER, PATIENT PRODUCT ID 3778-60 LOT# SERIAL# (B)(4), IMPLANTED: 2011 (B)(6), PRODUCT TYPE LEAD PRODUCT ID 3778-60 LOT# SERIAL# (B)(4), IMPLANTED: 2011 (B)(6), PRODUCT TYPE LEAD PRODUCT ID 37752 LOT# SERIAL# (B)(4), PRODUCT TYPE RECHARGER PRODUCT ID 37744 LOT# SERIAL# (B)(4), PRODUCT TYPE PROGRAMMER, PATIENT. (B)(4).

Description of Event or Problem · 1

IT WAS STATED, THE PATIENT EXPERIENCED A POWER ON RESET (POR) CODE ON THEIR PATIENT PROGRAMMER. IT WAS STATED, THE PATIENT WAS NOT ABLE TO ADJUST STIMULATION AND THAT THE PROGRAMMER WAS "ACTING UP" AND WAS HAVING A HARD TIME TURNING ON THE IMPLANTABLE NEUROSTIMULATOR (INS) WITH THE PROGRAMMER. IT WAS NOTED, THE PATIENT ONLY TURNED ON THE INS FOR 20-30 MINUTES WHEN SHE HAD PAIN THEN TURNED IT OFF. IT WAS ALSO NOTED ELECTRODES 8 AND 9 HAD HIGH IMPEDANCES BUT THESE WERE NOT USED IN PROGRAMMING. IT WAS STATED, THE PATIENT HAD AN X-RAY A FEW DAYS BEFORE REPORT. REPORTEDLY, STIMULATION WAS HELPING PATIENT WITH PAIN AND WHEN THE INS WAS ON, THEY DIDN'T HAVE ANY PROBLEMS WITH STIMULATION. IT WAS LATER REPORTED THAT THE PATIENT WAS HAVING PROBLEMS BECAUSE, THE BATTERIES IN THE PROGRAMMER WERE NEAR THE END OF LIFE. THE BATTERIES WERE REPLACED AND "ALL WAS FINE."

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
214708 PRIMEADVANCED STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF LGW MEDTRONIC MED REL MEDTRONIC PUERTO RICO 37702

Patients

Seq Age Sex Outcome Treatment
1