BEUDAMED
    FDA Adverse Event Injury Summary report: N

    OCTRODE

    MDR report key: 4143096 · Received September 23, 2014

    Report

    Report Number
    1627487-2014-26775
    Event Type
    Injury
    Date Received
    September 23, 2014
    Date of Event
    August 20, 2014
    Report Date
    September 3, 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 PATIENT'S MEDICAL HISTORY AN 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

    THE PATIENT IS IMPLANTED WITH A SYSTEM WHICH INCLUDED TWO LEADS FROM THE SAME LOT. IT WAS REPORTED THE PATIENT IS UNABLE TO INCREASE STIMULATION AND IS NOT RECEIVING STIMULATION SINCE SHE SUFFERED AN ACCIDENT. LEAD DIAGNOSTICS REVEALED HIGH IMPEDANCES. SURGICAL INTERVENTION MAY BE PENDING TO ADDRESS THIS ISSUE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    591292 OCTRODE SCS LEAD GZB ST. JUDE MEDICAL - NEUROMODULATION 3186 4507115

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Other SCS EXTENSIONS: MODEL 3383 (2)| IMPLANT DATE:| SCS IPG: MODEL 3716| IMPLANT DATE:| IMPLANT DATE:| SCS ANCHOR: MODEL 1194 (2)