BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LAMITRODE TRIPOLE 16

    MDR report key: 4092218 · Received September 3, 2014

    Report

    Report Number
    1627487-2014-26694
    Event Type
    Injury
    Date Received
    September 3, 2014
    Date of Event
    August 4, 2014
    Report Date
    August 11, 2014
    Manufacturer
    ST. JUDE MEDICAL - NEUROMODULATION
    Product Code
    GZB
    PMA / PMN Number
    P010032
    Adverse Event
    Yes
    Product Problem
    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 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

    DEVICE #1 OF 2: REFERENCE MFR. REPORT: 1627487-2014-26704. IT WAS REPORTED THE PT IS NOT RECEIVING STIMULATION AFTER HE SUFFERED A FALL, HOWEVER PRIOR TO THE FALL HE WAS NOT RECEIVING EFFECTIVE STIMULATION. LEAD DIAGNOSTICS SHOWED MULTIPLE LOW IMPEDANCES. REPROGRAMMING WAS UNABLE TO RESOLVE THE ISSUE. X-RAYS ARE PENDING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    535363 LAMITRODE TRIPOLE 16 SCS LEAD GZB ST. JUDE MEDICAL - NEUROMODULATION 3219 173015

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Other