BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PENTA

    MDR report key: 3821274 · Received May 9, 2014

    Report

    Report Number
    1627487-2014-25364
    Event Type
    Injury
    Date Received
    May 9, 2014
    Date of Event
    April 17, 2014
    Report Date
    April 17, 2014
    Manufacturer
    ST JUDE MEDICAL - NEUROMODULATION
    Product Code
    GZB
    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

    IT WAS REPORTED, THE PT IS EXPERIENCING INEFFECTIVE STIMULATION. X-RAYS REVEALED LEAD MIGRATION. IN TURN, THE PT IS GOING TO UNDERGO SURGICAL INTERVENTION TO REVISE THE LEAD. FOLLOW-UP IDENTIFIED THE PHYSICIAN INCREASED THE PT'S PAIN MEDICATION WHICH ADDRESSED HIS PAIN. AS A RESULT, THE PT REQUESTED TO HAVE THE SCS SYSTEM EXPLANTED DUE TO NO LONGER NEEDING IT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    282136 PENTA SCS LEAD GZB ST JUDE MEDICAL - NEUROMODULATION 3228 3860321

    Patients

    Seq Age Sex Outcome Treatment
    1 60 YR Other IMPLANT DATE:| SCS IPG: MODEL 3788