BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PENTA

    MDR report key: 3960156 · Received July 23, 2014

    Report

    Report Number
    1627487-2014-24050
    Event Type
    Injury
    Date Received
    July 23, 2014
    Date of Event
    July 1, 2014
    Report Date
    July 1, 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 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 EXPERIENCED UNCOMFORTABLE RIBS STIMULATION. A SJM REPRESENTATIVE ATTEMPTED REPROGRAMMING MULTIPLE TIMES TO NO AVAIL. THE PT STATED SHE RECENTLY HAD A FALL. FLUOROSCOPY REVEALED LEAD TAILS ARE COILED AROUND EACH OTHER. SURGICAL INTERVENTION WILL TAKE PLACE TO ADDRESS THE ISSUE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    429808 PENTA SCS LEAD GZB ST. JUDE MEDICAL - NEUROMODULATION 3228 4413733

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR Other IMPLANTED:| SCS IPG: MODEL 3788