BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PENTA

    MDR report key: 3192039 · Received June 20, 2013

    Report

    Report Number
    1627487-2013-08232
    Event Type
    Injury
    Date Received
    June 20, 2013
    Date of Event
    May 29, 2013
    Report Date
    May 29, 2013
    Manufacturer
    ST. JUDE MEDICAL - NEUROMODULATION
    Product Code
    GZB
    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 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. REFERENCE MFR REPORT: 1627487-2013-08248. IT WAS REPORTED THE PATIENT WAS SCHEDULED FOR AN EXPLANT AND THE REASON FOR IT WAS UNKNOWN. IT WAS STATED THE PATIENT WAS HAVING ISSUES UNRELATED TO THE DEVICE. FOLLOW-UP INFORMATION RECEIVED THE PATIENT POSTPONED THE SURGERY AND NO FURTHER INFORMATION WAS REPORTED. A SEARCH WAS PERFORMED OF THE DEVICE MANUFACTURER'S SYSTEM, AND NO PREVIOUS COMPLAINTS WERE FOUND.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    281811 PENTA SCS LEAD GZB ST. JUDE MEDICAL - NEUROMODULATION 3228 3415711

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR Other