BEUDAMED
    FDA Adverse Event Injury Summary report: N

    IPG

    MDR report key: 4142900 · Received September 23, 2014

    Report

    Report Number
    1627487-2014-01620
    Event Type
    Injury
    Date Received
    September 23, 2014
    Date of Event
    June 30, 2014
    Report Date
    September 3, 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 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 EXPERIENCED PAIN AT THE IPG POCKET SITE. SURGICAL INTERVENTION WAS UNDERTAKEN, EXPLANTING THE SCS SYSTEM. THE ISSUE IS RESOLVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    590823 IPG SCS IPG GZB ST. JUDE MEDICAL - NEUROMODULATION 3788 4327703

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR Other IMPLANT DATE:| SCS ANCHOR: MODEL, 1192(2)| SCS LEAD: MODEL, 3186 (2)| IMPLANT DATE: