FDA Adverse Event Injury Summary report: N

LAMITRODE 4 LEAD KIT, 60CM LENGTH

MDR report key: 6655622 · Received June 20, 2017

Report

Report Number: 1627487-2017-03314
Event Type: Injury
Date Received: June 20, 2017
Date of Event: May 24, 2017
Report Date: July 21, 2017
Manufacturer: ST. JUDE MEDICAL - NEUROMODULATION
Product Code: GZB
PMA / PMN Number: P010032
Adverse Event: Yes
Report Source: Manufacturer report
Reporter Location: AZ, US
Reporter Occupation: PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

IN THE EVENT THE DEVICE IS RETURNED TO THE MANUFACTURER, THE REPORTED EVENT CANNOT BE ANALYZED VIA LABORATORY TESTING. 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 4 OF 4. REFERENCE MFR. REPORT#: 1627487-003315; REFERENCE MFR. REPORT#: 1627487-003312; REFERENCE MFR. REPORT#: 1627487-003313. FOLLOW-UP INFORMATION REVEALED THE PATIENT'S INFECTION WAS RESOLVING. NO OTHER INTERVENTIONS HAVE BEEN PLANNED.

Description of Event or Problem · 1

DEVICE 4 OF 4: REFERENCE MFR. REPORT#: 1627487-003315, REFERENCE MFR. REPORT#: 1627487-003312, REFERENCE MFR. REPORT#: 1627487-003313. IT WAS REPORTED THE PATIENT HAS AN INFECTION AT THE RIGHT SUPRA-ORBITAL LEAD SITE. IT IS UNKNOWN WHEN THE INFECTION FIRST STARTED. THE PATIENT WAS PRESCRIBED ANTIBIOTICS AND THE INFECTION WILL BE MONITORED. FOLLOW-UP INFORMATION REVEALED THE PATIENT HAS COMPLETED THE ANTIBIOTICS AND WILL MEET WITH A SURGEON AS THE NEXT COURSE OF ACTION,

Devices

Seq	Brand	Generic	Product Code	Manufacturer	Model	Lot	UDI-DI
435317	LAMITRODE 4 LEAD KIT, 60CM LENGTH	SCS LEAD	GZB	ST. JUDE MEDICAL - NEUROMODULATION	3240	5418608

Patients

Seq	Age	Sex	Outcome	Treatment
1	44 YR		Other