BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PENTA

    MDR report key: 3182172 · Received June 14, 2013

    Report

    Report Number
    1627487-2013-01695
    Event Type
    Injury
    Date Received
    June 14, 2013
    Date of Event
    April 26, 2013
    Report Date
    May 22, 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

    EVAL: METHOD- THE DEVICE HISTORY AND STERILIZATION RECORDS WERE REVIEWED. RESULTS- REVIEW OF THE DHR FOUND A NONCONFORMANCE RELATED TO THE PRODUCT LOT. HOWEVER, THE INDIVIDUAL AFFECTED DEVICE WAS REWORKED AND ALL DEVICES WITHIN THE LOT MET ACCEPTANCE CRITERIA. THEREFORE, THE DHR ANOMALY IS NOT RELATED TO THE ALLEGED DEVICE COMPLAINT. CONCLUSION - THE CAUSE OF THE REPORTED COMPLAINT COULD NOT BE DETERMINED FROM THE REVIEW OF THE DHR AND STERILIZATION RECORDS. 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

    DEVICE 2 OF 2. REFERENCE MFR REPORT: 1627487-2013-01694. IT WAS REPORTED THE PATIENT'S ENTIRE SCS SYSTEM WAS REMOVED DUE TO INFECTION (UNK LOCATION).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    271609 PENTA SCS LEAD LGW ST. JUDE MEDICAL -NEUROMODULATION 3228 3815199

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR Other