FDA Adverse Event Injury Summary report: N

PRIMEADVANCED

MDR report key: 4223010 · Received November 4, 2014

Report

Report Number
9614453-2014-02583
Event Type
Injury
Date Received
November 4, 2014
Report Date
October 6, 2014
Manufacturer
IPG MFG SWITZERLAND
Product Code
LGW
PMA / PMN Number
P840001
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MN, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

(B)(4).

Additional Manufacturer Narrative · 1

CONCOMITANT MEDICAL PRODUCTS: PRODUCT ID: 37081-60, SERIAL# (B)(4), EXPLANTED: (B)(6) 2014, PRODUCT TYPE: EXTENSION. PRODUCT ID: 37081-60, SERIAL# (B)(4), EXPLANTED: (B)(6) 2014, PRODUCT TYPE: EXTENSION. (B)(4).

Description of Event or Problem · 1

IT WAS REPORTED THE PATIENT¿S EXTENSIONS WERE REPLACED BECAUSE THEY WERE ¿BROKEN.¿ IMPEDANCE TESTING WAS PERFORMED AND FOUND HIGH IMPEDANCES OF ¿>10000¿ OHMS THAT WERE ATTRIBUTED TO THE PATIENT¿S EXTENSIONS. THE PATIENT REPORTEDLY EXPERIENCED A LACK OF THERAPY DUE TO THE EVENT. THERE WERE NO PATIENT FALLS REPORTED. THE REPORTING MANUFACTURER REPRESENTATIVE ¿GUESSED THAT PROBABLY THE PROBLEM WAS (DUE TO) MOVEMENT OF THE IMPLANTABLE NEUROSTIMULATOR (INS).¿ FOLLOWING THE REPLACEMENT OF THE PATIENT¿S EXTENSIONS, THE PATIENT WAS NOTABLY ¿OK.¿ A SUPPLEMENTAL REPORT WILL BE FILED IF ADDITIONAL INFORMATION IS RECEIVED.

Description of Event or Problem · 1

ADDITIONAL INFORMATION RECEIVED REPORTED THAT BOTH EXTENSIONS HAD IMPEDANCE GREATER THAN 10,000 OHMS AND BOTH WERE BROKEN. BOTH OF THE EXTENSIONS WERE EXPLANTED AND REPLACED.

Description of Event or Problem · 1

ADDITIONAL INFORMATION RECEIVED REPORTED THE EXTENSION WERE BROKEN BECAUSE THE IMPLANTABLE NEUROSTIMULATOR (INS) TURNED ON THE IMPLANT SITE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
708013 PRIMEADVANCED STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF LGW IPG MFG SWITZERLAND 37702

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention