BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LAMITRODE

    MDR report key: 4202016 · Received October 17, 2014

    Report

    Report Number
    1627487-2014-26865
    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

    (B)(4). 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

    DEVICE 3 OF 3. REF MFR REPORT: 1627487-2014-26863 AND 1627487-2014-26864.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    663348 LAMITRODE SCS LEAD GZB ST. JUDE MEDICAL - NEUROMODULATION 3286 3757714

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR Other SCS IPG, MODEL 3788,| SCS EXTENSION, MODEL 3343,| IMPLANT DATE:| IMPLANT DATE:| SCS ANCHOR, MODEL 1192,| IMPLANT DATE: