BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LAMITRODE 4

    MDR report key: 3764199 · Received March 21, 2014

    Report

    Report Number
    1627487-2014-04169
    Event Type
    Injury
    Date Received
    March 21, 2014
    Date of Event
    February 4, 2014
    Report Date
    February 27, 2014
    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

    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 2 OF 2. REFERENCE MFT REPORT: 1627487-2014-04168.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    169268 LAMITRODE 4 SCS LEAD LGW ST. JUDE MEDICAL - NEUROMODULATION 3240 4260695

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR SCS IPG: MODEL 3788| IMPLANT DATE: