MAUDE Adverse Event Report: ST JUDE MEDICAL - NEUROMODULATION EON MINI; SCS IPG

Model Number 3788

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problem Purulent Discharge (1812)

Event Date 07/07/2014

Event Type  Injury  

Event Description

Device 1 of 2: reference mfr.Report: 1627487-2014-24056; it was reported the patient underwent surgical intervention on (b)(6) 2014 due to a suspected infection.The physician opened the mid-back and pocket incisions and saw no sign of infection.A foreign body believed to be a previous anchor (lead kit) was removed due to pus found in a previous lead track between the ipg and anchor site.Patient has been on antibiotics post-operatively.

Manufacturer Narrative

The device history and sterilization records were reviewed.The device history and sterilization records were reviewed to meet specifications and no anomalies related to this event were found.The cause of the reported complaint could not be determined from the review of the dhr and sterilization records.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.

• Brand Name: EON MINI
• Type of Device: SCS IPG
• Manufacturer (Section D): ST JUDE MEDICAL - NEUROMODULATION; plano TX
• Manufacturer Contact: jane mwambu ; 6901 preston road; plano, TX 75024 ; 9723098568
• MDR Report Key: 4008708
• MDR Text Key: 17987102
• Report Number: 1627487-2014-24055
• Device Sequence Number: 1
• Product Code: GZB
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: P010032
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative
• Reporter Occupation: Not Applicable
• Type of Report: Initial
• Report Date: 07/07/2014

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/01/2014
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 12/01/2015
• Device Model Number: 3788
• Device Lot Number: 4401009
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 07/07/2014
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 12/01/2013
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Other
• Patient Age: 49 YR