BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PENTA

    MDR report key: 4201967 · Received October 17, 2014

    Report

    Report Number
    1627487-2014-26862
    Event Type
    Injury
    Date Received
    October 17, 2014
    Date of Event
    September 26, 2014
    Report Date
    September 26, 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 IS NO LONGER RECEIVING EFFECTIVE STIMULATION AND IS RECEIVING UNINTENDED RIGHT LEG STIMULATION. REPROGRAMMING WAS UNABLE TO RESOLVE THE ISSUE. SURGICAL INTERVENTION MAY BE PENDING TO ADDRESS THIS ISSUE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    663330 PENTA SCS LEAD GZB ST. JUDE MEDICAL - NEUROMODULATION 3228 4453055

    Patients

    Seq Age Sex Outcome Treatment
    1 81 YR Other