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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: GIVEN IMAGING LOS ANGELES LLC PISCES Z QUAD; STIMULATOR, SPINAL-CORD, IMPLANTED (PAIN RELIEF)

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GIVEN IMAGING LOS ANGELES LLC PISCES Z QUAD; STIMULATOR, SPINAL-CORD, IMPLANTED (PAIN RELIEF) Back to Search Results
Model Number 3890
Device Problems Break (1069); Difficult to Remove (1528)
Patient Problem No Code Available (3191)
Event Type  Injury  
Manufacturer Narrative
(b)(4).If information is provided in the future, a supplemental report will be issued.
 
Event Description
According to the reporter, the catheter had a damaged flex harness.The catheter also got stuck in the patient and an ent was needed to have it removed.The patient is currently fine.
 
Manufacturer Narrative
H3: evaluation summary: one device was received for evaluation.The visual inspection found sensor damage.The tpe is damaged, the sensor is damaged where the tpe damage occurred.The tpe damage allowed reprocessing fluid to be introduced into the catheter, resulting in corrosion.The customer reported that the catheter doesn¿t calibrate.The reported condition was confirmed.The investigation found sensor #9 is unstable.There is an intermittent break every 6th sensor.All impedance sensors have signal and are functional in saline solution.The pico scope data shows sensors #9 is unstable.The investigation found the most probable cause to be the sensor damage.The probable root cause was found to be user mishandling.Medtronic is submitting this report to comply with fda reporting regulations under 21 cfr parts 4 and 803.This report is based upon information obtained by medtronic, which the company may not have been able to fully investigate or verify prior to the date the report was required by the fda.Medtronic has made reasonable efforts to obtain more complete information and has provided as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.In particular, this report does not constitute an admission by anyone that the product described in this report has any ¿defects¿ or has ¿malfunctioned¿.These words are included in the fda 3500a form and are fixed items for selection created by the fda to categorize the type of event solely for the purpose of regulatory reporting.Medtronic objects to the use of these words and others like them because of the lack of definition and the connotations implied by these terms.This statement should be included with any information or report disclosed to the public under the freedom of information act.
 
Event Description
According to the reporter, the catheter had a damaged flex harness after the procedure.However, the catheter got stuck in the patient and an ent was needed to have it removed.The patient is currently fine.
 
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Brand Name
PISCES Z QUAD
Type of Device
STIMULATOR, SPINAL-CORD, IMPLANTED (PAIN RELIEF)
Manufacturer (Section D)
GIVEN IMAGING LOS ANGELES LLC
5860 uplander way
culver city CA 90230
MDR Report Key9433476
MDR Text Key172022076
Report Number3005344223-2019-00017
Device Sequence Number1
Product Code GZB
UDI-Device Identifier04260167482446
UDI-Public04260167482446
Combination Product (y/n)N
PMA/PMN Number
K091070
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type user facility
Type of Report Initial,Followup
Report Date 02/11/2020
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received12/06/2019
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Model Number3890
Device Catalogue Number3890
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer11/19/2019
Date Manufacturer Received01/28/2020
Is This a Reprocessed and Reused Single-Use Device? No
Patient Sequence Number1
Patient Outcome(s) Required Intervention;
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