MAUDE Adverse Event Report: ST. JUDE MEDICAL - NEUROMODULATION IMPLANTABLE NEUROSTIMULATOR KIT; DRG IPG

Model Number MN10200

Device Problems Charging Problem (2892); Wireless Communication Problem (3283)

Patient Problem No Known Impact Or Consequence To Patient (2692)

Event Date 08/21/2020

Event Type  Injury  

Manufacturer Narrative

Date of event is estimated.The results/ method and conclusion codes along with investigation results will be provided in the final report.

Event Description

It was reported the patient's ipg was replaced on (b)(6) 2020 due to connecting and recharging difficulty.Effective therapy was restored post-op.

Manufacturer Narrative

The results of the investigation are inconclusive since the device was not returned for analysis.   based on the information received, the cause of the reported incident could not be conclusively determined.

• Brand Name: IMPLANTABLE NEUROSTIMULATOR KIT
• Type of Device: DRG IPG
• Manufacturer (Section D): ST. JUDE MEDICAL - NEUROMODULATION; 6901 preston rd; plano TX 75024
• MDR Report Key: 10508864
• MDR Text Key: 206162004
• Report Number: 1627487-2020-30912
• Device Sequence Number: 1
• Product Code: PMP
• UDI-Device Identifier: 05415067025500
• UDI-Public: 05415067025500
• Combination Product (y/n): N
• PMA/PMN Number: P150004
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,health
• Type of Report: Initial,Followup
• Report Date: 10/29/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 09/09/2020
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 04/07/2019
• Device Model Number: MN10200
• Device Catalogue Number: MN10200
• Device Lot Number: DB7522
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 10/27/2020
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Other
• Patient Age: 45 YR
• Patient Weight: 125