BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MEDTRONIC

    MDR report key: 5108265 · Received December 30, 2004

    Report

    Report Number
    5108265
    Event Type
    Injury
    Date Received
    December 30, 2004
    Date of Event
    July 28, 2004
    Report Date
    November 22, 2004
    Manufacturer
    MEDTRONIC INC YSA
    Product Code
    LKK
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    MT, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    MIGRATED INTRATHECAL CATHETER AND LOOSE DRUG ADMINISTRATION PUMP IN THE ABDOMINAL POCKET. MEDICAL MANAGEMENT OF ACUTE OPIOID WITHDRAWAL AND DISPLACED INTRATHECAL CATHETER. CSF LEAK. INTRATHECAL CATHETER WAS REPLACED AND DRUG ADMINISTRATION PUMP WAS RESUTURED. MFR: 6000030-2004-01771.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDTRONIC INTRATHECAL CATHETER LKK MEDTRONIC INC YSA 8731 B009449N30

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR