MAUDE Adverse Event Report: ST. JUDE MEDICAL - NEUROMODULATION SWIFT-LOCK ANCHOR; SCS ANCHOR

Model Number 1192

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

Patient Problem Post Operative Wound Infection (2446)

Event Type  Injury  

Manufacturer Narrative

The event date is estimated to be (b)(6) 2019.The results/method and conclusion codes along with the investigation results will be provided in the final report.Concomitant medical products and therapy dates: model: 3660, scs ipg, therapy date: (b)(6) 2019.Model: 3156 (x2), scs leads, therapy date: (b)(6) 2019.Model: 3186, scs lead, therapy date: (b)(6) 2019.Model: 3341 (x2), scs extensions, therapy date: (b)(6) 2019.Model: 3383, scs extension, therapy date: (b)(6) 2019.

Event Description

Device 8 of 8.Reference mfr.Report#: 3006705815-2019-04918.Reference mfr.Report#: 1627487-2019-13954.Reference mfr.Report#: 1627487-2019-13955.Reference mfr.Report#: 3006705815-2019-04919.Reference mfr.Report#: 1627487-2019-13956.Reference mfr.Report#: 1627487-2019-13957.Reference mfr.Report#: 1627487-2019-13958.It was reported the patient was diagnosed with an infection at their ipg and lead sites.In turn, the patient's scs system was explanted to address the issue.

Manufacturer Narrative

A review of the lot history record identified no manufacturing nonconformities issued to the reported device that would have contributed to this event.Based on the information provided a device problem was not identified, as a result a conclusive cause for the reported patient effect, and the relationship to the product, if any, cannot be determined.

Event Description

Device 8 of 8 reference mfr.Report#: 3006705815-2019-04918; reference mfr.Report#: 1627487-2019-13954; reference mfr.Report#: 1627487-2019-13955; reference mfr.Report#: 3006705815-2019-04919; reference mfr.Report#: 1627487-2019-13956; reference mfr.Report#: 1627487-2019-13957; reference mfr.Report#: 1627487-2019-13958.

• Brand Name: SWIFT-LOCK ANCHOR
• Type of Device: SCS ANCHOR
• Manufacturer (Section D): ST. JUDE MEDICAL - NEUROMODULATION; 6901 preston rd; plano TX 75024
• Manufacturer (Section G): ST. JUDE MEDICAL - NEUROMODULATION; 6901 preston rd; plano TX 75024
• Manufacturer Contact: andrea deitz ; 6901 preston road; plano, TX 75024 ; 9723098000
• MDR Report Key: 9474757
• MDR Text Key: 170926059
• Report Number: 1627487-2019-13959
• Device Sequence Number: 1
• Product Code: GZB
• UDI-Device Identifier: 05414734400671
• UDI-Public: 05414734400671
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K092371
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,health
• Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date: 02/11/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 07/02/2021
• Device Model Number: 1192
• Device Catalogue Number: 1192
• Device Lot Number: 7065764
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Initial Date Manufacturer Received: 11/25/2019
• Initial Date FDA Received: 12/16/2019
• Supplement Dates Manufacturer Received: 02/04/2020
• Supplement Dates FDA Received: 02/11/2020
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 07/03/2019
• 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 Weight: 68