BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EON MINI

    MDR report key: 3141762 · Received May 28, 2013

    Report

    Report Number
    1627487-2013-08147
    Event Type
    Injury
    Date Received
    May 28, 2013
    Date of Event
    April 30, 2013
    Report Date
    May 2, 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

    RESULTS: THE IPG WAS RETURNED FOR DISPOSAL. NO FUNCTIONAL TESTING WAS PERFORMED. THE LOWER PORT CONNECTOR OF THE IPG HEADER HAS THE LEAD TIP LODGED INTO IT. THIS IS CONSISTENT WITH FORCIBLY PULLING THE LEAD OUT PRIOR TO RELEASING THE SETSCREW. 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

    DEVICE 1 OF 2. REF MFR REPORT #1627487-2013-08148. IT WAS REPORTED THE PT HAD HER PNS SYSTEM (OFF-LABEL USE) EXPLANTED ON (B)(6) 2013. PT WAS INITIALLY EXPERIENCING PAIN RELIEF BUT WAS HAVING NAUSEA FROM HER MEDICATION. LATER ON, IT WAS STATED THE PT WAS EXPERIENCING NUMBNESS IN HER HEAD AND WAS NOT HAVING PAIN RELIEF. PT WAS OFFERED THE REPROGRAMMING OPTION, BUT WAS DENIED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    233200 EON MINI SCS IPG LGW ST. JUDE MEDICAL - NEUROMODULATION 3788 3888418

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Required Intervention SCS EXTENSION, MODEL 3386| IMPLANT DATE: