FDA Adverse Event Injury Summary report: N

RESTORE SENSOR SURESCAN MRI

MDR report key: 3781997 · Received April 30, 2014

Report

Report Number
3004209178-2014-08317
Event Type
Injury
Date Received
April 30, 2014
Report Date
April 8, 2014
Manufacturer
MEDTRONIC PUERTO RICO OPERATIONS CO.
Product Code
LGW
PMA / PMN Number
P840001
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
MN, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

PRODUCT ID 39565-65, SERIAL# (B)(4), IMPLANTED: 2014 (B)(6); PRODUCT TYPE LEAD PRODUCT ID 97754, SERIAL# (B)(4), PRODUCT TYPE RECHARGER PRODUCT ID 97740, SERIAL# (B)(4), PRODUCT TYPE PROGRAMMER, PATIENT. (B)(4).

Additional Manufacturer Narrative · 1

(B)(4)

Description of Event or Problem · 1

IT WAS REPORTED THE PATIENT HAD IMPROVED SIGNIFICANTLY. IT WAS NOTED THE PATIENT WAS TO BE RELEASED FROM REHAB THE DAY AFTER REPORT. IT WAS REPORTED THE PATIENT¿S WEAKNESS WAS DUE TO A SPINAL ISCHEMIC EVENT, NOT THE STIMULATOR.

Description of Event or Problem · 1

IT WAS REPORTED THAT DURING AN IMPLANT PROCEDURE OF A SPINAL CORD STIMULATOR, THE PATIENT EXPERIENCED NUMBNESS AND WEAKNESS IN HER LEFT LEG UPON AWAKENING FROM SURGERY. IT WAS REPORTED THERE WAS ¿SUSPICION¿ THAT THE PATIENT EXPERIENCED ¿SOME TYPE OF SPINAL STROKE¿ DURING THE PROCEDURE. IT WAS REPORTED MORE TESTING WAS TO BE PERFORMED. IT WAS NOTED THAT THERE WAS NO ALLEGED PRODUCT ISSUE. THE PATIENT REPORTEDLY REQUIRED HOSPITALIZATION AS A RESULT OF THE EVENT. THE PATIENT¿S STATUS AT THE TIME OF THE CURRENT REPORT WAS NOTED TO BE ALIVE WITH INJURY. ADDITIONAL INFORMATION HAS BEEN REQUESTED, BUT IT WAS NOT AVAILABLE AT THE TIME OF THIS INITIAL REPORT. A SUPPLEMENTAL REPORT WILL BE SENT IF ANY ADDITIONAL INFORMATION IS RECEIVED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
260123 RESTORE SENSOR SURESCAN MRI STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF LGW MEDTRONIC PUERTO RICO OPERATIONS CO. 97714

Patients

Seq Age Sex Outcome Treatment
1 00068 YR Hospitalization