BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SOLETRA

    MDR report key: 5128469 · Received October 5, 2015

    Report

    Report Number
    3004209178-2015-20019
    Event Type
    Malfunction
    Date Received
    October 5, 2015
    Report Date
    September 10, 2015
    Manufacturer
    MEDTRONIC MED REL MEDTRONIC PUERTO RICO
    Product Code
    MHY
    PMA / PMN Number
    P960009
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KY, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    CONCOMITANT PRODUCTS: PRODUCT ID 7426, SERIAL # (B)(4), IMPLANTED: (B)(6) 2010, PRODUCT TYPE IMPLANTABLE NEUROSTIMULATOR; PRODUCT ID 3387S-40, LOT # V331504, IMPLANTED: (B)(6) 2010, PRODUCT TYPE LEAD; PRODUCT ID 7482A51, SERIAL # (B)(4), IMPLANTED: (B)(6) 2010, PRODUCT TYPE EXTENSION; PRODUCT ID 3387S-40, LOT # V285124, IMPLANTED: (B)(6) 2009, PRODUCT TYPE LEAD; PRODUCT ID 3550-05, LOT # N221537, IMPLANTED: (B)(6) 2009, PRODUCT TYPE ACCESSORY; PRODUCT ID 7482A51, SERIAL # (B)(4), IMPLANTED: (B)(6) 2009, PRODUCT TYPE EXTENSION; PRODUCT ID 3550-05, LOT # N221537, IMPLANTED: (B)(6) 2009, PRODUCT TYPE ACCESSORY. (B)(4).

    Description of Event or Problem · 1

    INFORMATION WAS RECEIVED FROM THE PATIENT THAT REPORTED THEY DIDN¿T FEEL THE DEEP BRAIN STIMULATOR (DBS) WAS WORKING ANYMORE. THE DEVICE WAS HELPING TO CONTROL HIS TREMORS BUT NOW THEY HAD MODERATE HEAD AND NECK TREMORS. THE PATIENT WAS IMPLANTED FOR ESSENTIAL TREMOR. FURTHER FOLLOW-UP IS BEING CONDUCTED TO DETERMINE WHAT STEPS WERE TAKEN TO RESOLVE THE HEAD AND NECK TREMORS. IF ADDITIONAL INFORMATION IS RECEIVED, A FOLLOW-UP REPORT WILL BE SUBMITTED. **PLEASE SEE MANUFACTURER REPORT #3004209178-2015-20017 FOR INFORMATION ON THE PATIENT'S CONCOMITANT SYSTEM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    659473 SOLETRA STIMULATOR, ELECTRICAL, IMPLANTED, FOR PARKINSONIAN TREMOR MHY MEDTRONIC MED REL MEDTRONIC PUERTO RICO 7426

    Patients

    Seq Age Sex Outcome Treatment
    1 00044 YR