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

Model Number 3716

Device Problems Disconnection (1171); Pocket Stimulation (1463)

Patient Problem Inadequate Pain Relief (2388)

Event Date 09/22/2014

Event Type  Injury  

Event Description

Device 1 of 4.Reference mfr report: 1627487-2014-24370, 24371, 24374.It was reported the pt experienced uncomfortable ipg pocket stimulation and ineffective stimulation.Diagnostics indicated invalid impedance readings with two leads.X-rays revealed the lead had pulled of out of the ipg header.Surgical intervention will be taken at a later date.

Manufacturer Narrative

Sjm has limited information related to the pt's medical history and is unable to form an opinion as to the relevancy of the pt's history to the event reported.Sjm defers to the pt's physician regarding medical history.

• Brand Name: EON
• Type of Device: SCS IPG
• Manufacturer (Section D): ST. JUDE MEDICAL - NEUROMODULATION; plano TX
• Manufacturer Contact: jane mwambu ; 6901 preston rd.; plano, TX 75024 ; 9723098568
• MDR Report Key: 4254194
• MDR Text Key: 5044435
• Report Number: 1627487-2014-24369
• 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: 11/06/2014

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 11/13/2014
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 09/01/2012
• Device Model Number: 3716
• Device Lot Number: 3203800
• Other Device ID Number: 05414734402583
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 11/06/2014
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 09/01/2010
• 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: 35 YR