BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EON

    MDR report key: 3192065 · Received June 20, 2013

    Report

    Report Number
    1627487-2013-01720
    Event Type
    Injury
    Date Received
    June 20, 2013
    Date of Event
    May 25, 2013
    Report Date
    May 27, 2013
    Manufacturer
    ST. JUDE MEDICAL - NEUROMODULATION
    Product Code
    LGW
    PMA / PMN Number
    P010032
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, 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

    IT WAS REPORTED, THE PT IS EXPERIENCING A SHARP SHOOTING PAIN AT HER IPG SITE WITH STIMULATION ON OR OFF. THE PT WAS ADVISED TO CONSULT HER PHYSICIAN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    281032 EON SCS IPG LGW ST. JUDE MEDICAL - NEUROMODULATION 3716 56342

    Patients

    Seq Age Sex Outcome Treatment
    1 51 YR Other IMPLANT DATE:| SCS LEAD, MODEL 3344| SCS EXTENSION, MODEL 3383| IMPLANT DATE: