BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PENTA

    MDR report key: 3193619 · Received June 25, 2013

    Report

    Report Number
    1627487-2013-13967
    Event Type
    Injury
    Date Received
    June 25, 2013
    Date of Event
    December 27, 2012
    Report Date
    May 31, 2013
    Manufacturer
    ST. JUDE MEDICAL - NEUROMODULATION
    Product Code
    LGW
    PMA / PMN Number
    P010032
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, 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

    THE PATIENT REPORTED SHE WAS NOT RECEIVING EFFECTIVE STIMULATION. THE PATIENT'S SCS SYSTEM WAS EXPLANTED, DATE UNKNOWN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    288431 PENTA SCS LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3228 3517929

    Patients

    Seq Age Sex Outcome Treatment
    1 45 YR Other SCS IPG: MODEL 3788| IMPLANT: