FDA Adverse Event Injury Summary report: N

PUMP, INFUSION, IMPLANTED, PROGRAMMABLE

MDR report key: 3874771 · Received June 16, 2014

Report

Report Number
3007566237-2014-01665
Event Type
Injury
Date Received
June 16, 2014
Report Date
May 27, 2014
Manufacturer
MEDTRONIC NEUROMODULATION
Product Code
LKK
PMA / PMN Number
P860004
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

CONCOMITANT PRODUCT: PRODUCT ID: NEU_UNKNOWN_CATH, LOT# SERIAL# UNKNOWN, PRODUCT TYPE: CATHETER. (B)(4).

Description of Event or Problem · 1

IT WAS REPORTED THAT THE PUMP SYSTEM WAS REMOVED DUE TO INFECTION. ADDITIONAL INFORMATION HAS BEEN REQUESTED, BUT WAS NOT AVAILABLE AS OF THE DATE OF THIS REPORT.

Description of Event or Problem · 1

ADDITIONAL INFORMATION RECEIVED REPORTED THAT THE PUMP WAS STILL IMPLANTED AS IT WAS NOT AFFECTED. IT WAS STATED THAT THEY ONLY REMOVED THE CATHETER. THE SPINAL INFECTION WAS AS A RESULT OF A SPINAL SURGERY. IT WAS NOTED THAT THE INFECTION WAS CLEAR. ADDITIONAL INFORMATION HAS BEEN REQUESTED, BUT WAS NOT AVAILABLE AS OF THE DATE OF THIS REPORT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
352538 PUMP, INFUSION, IMPLANTED, PROGRAMMABLE LKK MEDTRONIC NEUROMODULATION NEU_UNKNOWN_PUMP

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention