FDA Adverse Event Injury Summary report: N

RESTORE

MDR report key: 3120552 · Received May 20, 2013

Report

Report Number
3004209178-2013-07914
Event Type
Injury
Date Received
May 20, 2013
Report Date
February 1, 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
TX, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

PRODUCT ID: 377775 LOT# J0555087V, IMPLANTED: 2005 (B)(6), PRODUCT TYPE LEAD PRODUCT ID: 377775 LOT# J0555087V, IMPLANTED: 2005 (B)(6), PRODUCT TYPE LEAD PRODUCT ID: 37752 LOT# SERIAL# (B)(4), PRODUCT TYPE RECHARGER PRODUCT ID: 37742 LOT# SERIAL# (B)(4), PRODUCT TYPE PROGRAMMER, PATIENT PRODUCT ID: 3708120 LOT# SERIAL# (B)(4), IMPLANTED: 2005 (B)(6), PRODUCT TYPE EXTENSION PRODUCT ID: 3708120 LOT# SERIAL# (B)(4), IMPLANTED: 2005 (B)(6), PRODUCT TYPE EXTENSION (B)(4). ANALYSIS RESULTS WERE NOT AVAILABLE AS OF THE DATE OF THIS REPORT. A FOLLOW-UP REPORT WILL BE SUBMITTED WHEN ANALYSIS IS COMPLETE.

Additional Manufacturer Narrative · 1

(B)(4).

Additional Manufacturer Narrative · 1

FINAL ANALYSIS OF THE PATIENT¿S IMPLANTABLE NEUROSTIMULATOR (INS) REVEALED THE INS HAD ¿REDUCED CAPACITY DUE TO OVERDISCHARGE.¿

Additional Manufacturer Narrative · 1

IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

Additional Manufacturer Narrative · 1

(B)(4).

Description of Event or Problem · 1

IT WAS REPORTED, THE PATIENT PREVIOUSLY HAD DIFFICULTY WITH RECHARGING AND THEN DID NOT NEED TO USE HIS STIMULATOR DUE TO DECREASED PAIN. THE PATIENT¿S PAIN RETURNED SO HE OPTED TO REPLACE THE BATTERY. IT WAS NOTED BATTERY DEPLETION WAS NOT NORMAL. THE PATIENT RECOVERED WITHOUT SEQUELA.

Description of Event or Problem · 1

IT WAS NOTED THE PATIENT HAD "NOT RECHARGED."

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
222761 RESTORE STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF LGW MEDTRONIC MED REL MEDTRONIC PUERTO RICO 37711

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention