FDA Adverse Event
Injury
Summary report: N
EON MINI
MDR report key: 4143079
·
Received September 23, 2014
Report
- Report Number
- 1627487-2014-12640
- Event Type
- Injury
- Date Received
- September 23, 2014
- Date of Event
- August 28, 2014
- Report Date
- August 30, 2014
- Manufacturer
- ST. JUDE MEDICAL - NEUROMODULATION
- Product Code
- GZB
- PMA / PMN Number
- P010032
- Removal / Correction Number
- 1627487-07262012-002-R
- Adverse Event
- Yes
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- TX, US
- Reporter Occupation
- NOT APPLICABLE
Narratives
Additional Manufacturer Narrative · 1
RECALL: THIS IPG SERIAL NUMBER WAS INCLUDED IN A FIELD ADVISORY. 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 PT'S IPG REQUIRED EXCESSIVE CHARGING. A REPLACEMENT CHARGER DID NOT RESOLVE THE ISSUE. THE IPG WAS EXPLANTED AND REPLACED. THE PT'S ISSUE WAS RESOLVED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 591190 | EON MINI | SCS IPG | GZB | ST. JUDE MEDICAL - NEUROMODULATION | 3788 | 3389156 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 70 YR | Other | IMPLANT DATE:| SCS ANCHORS, MODEL: 1192| SCS LEADS, MODEL: 3186| IMPLANT DATE: |