BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EON MINI

    MDR report key: 3961274 · Received July 18, 2014

    Report

    Report Number
    1627487-2014-23474
    Event Type
    Injury
    Date Received
    July 18, 2014
    Date of Event
    June 25, 2014
    Report Date
    June 25, 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 PATIENT IS EXPERIENCING COMPLICATIONS FROM IPG MIGRATION. FOLLOW-UP INFORMATION REVEALED THE PATIENT IS NOW EXPERIENCING CHEST PAINS. THE PATIENT WILL SURGICAL INTERVENTION PENDING CARDIAC CLEARANCE TO ADDRESS THE REPORTED ISSUE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    421034 EON MINI SCS PG GZB ST. JUDE MEDICAL - NEUROMODULATION 3788 3948001

    Patients

    Seq Age Sex Outcome Treatment
    1 67 YR Other IMPLANT DATE:| IMPLANT DATE:| SCS ANCHOR, MODEL: 1194 (2)| SCS LEAD, MODEL: 3228