BEUDAMED
    FDA Adverse Event Death Summary report: N

    EON MINI

    MDR report key: 3202086 · Received June 26, 2013

    Report

    Report Number
    1627487-2013-15858
    Event Type
    Death
    Date Received
    June 26, 2013
    Date of Event
    June 4, 2013
    Report Date
    June 4, 2013
    Manufacturer
    ST. JUDE MEDICAL - NEUROMODULATION
    Product Code
    LGW
    PMA / PMN Number
    P010032
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SC, 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 HAD PASSED AWAY. THE CAUSE OF DEATH IS CURRENTLY UNK. F/U WITH THE SJM FIELD REP AND IMPLANTING PHYSICIAN IDENTIFIED THEY WERE NOT INFORMED OF THE PT'S DEATH AND COULD NOT OFFER ANY ADDITIONAL INFO.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    290646 EON MINI SCS IPG LGW ST. JUDE MEDICAL - NEUROMODULATION 3788 3540052

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR Death IMPLANT DATE:| SCS LEAD: MODEL 3163| IMPLANT DATE:| SCS LEAD: MODEL 3245