BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OCTRODE

    MDR report key: 3141871 · Received May 28, 2013

    Report

    Report Number
    1627487-2013-05743
    Event Type
    Injury
    Date Received
    May 28, 2013
    Date of Event
    April 12, 2013
    Report Date
    May 3, 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 INFO RELATED TO THE PT'S MEDICAL HISTORY AND IS UNABLE TO FORM AN OPINION AS TO THE RELEVANCY OF THE PT'S HISTORY TO THE EVENT REPORTED. SJM DEFERS TO THE PT'S PHYSICIAN REGARDING MEDICAL HISTORY.

    Description of Event or Problem · 1

    IT WAS REPORTED THE PT EXPERIENCES SPASMS IN HER LEG WHEN STIMULATION IS ON. REPROGRAMMING WAS UNSUCCESSFUL. THE PT PLANS TO MEET UP WITH HER DOCTOR ABOUT THE ISSUE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    233407 OCTRODE SCS LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3186 3733736

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Required Intervention SCS ANCHOR: MODEL 1192| SCS IPG: MODEL 3788| IMPLANT DATE:| IMPLANT DATE: