BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EON

    MDR report key: 4091890 · Received August 28, 2014

    Report

    Report Number
    1627487-2014-23557
    Event Type
    Injury
    Date Received
    August 28, 2014
    Date of Event
    August 5, 2014
    Report Date
    August 5, 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 HAD FALLEN ON HIS IPG SITE. AS A RESULT, THE PATIENT IS COMPLAINING OF PAIN UNDER THE IPG SITE THAT RADIATES THROUGH HIS JOINTS INTO HIS LEFT LEG. DIAGNOSTIC TESTING DID NOT REVEAL ANY ANOMALIES. SURGICAL INTERVENTION IS PENDING TO ADDRESS THE REPORTED ISSUE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    526130 EON SCS IPG GZB ST. JUDE MEDICAL - NEUROMODULATION 3716 3170802

    Patients

    Seq Age Sex Outcome Treatment
    1 60 YR Other MODEL 3186 (2)| IMPLANT DATE: