• Decrease font size
  • Return font size to normal
  • Increase font size
U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ST. JUDE MEDICAL - NEUROMODULATION (PUERTO RICO, LLC) OCTRODE LEAD KIT, 60CM LENGTH; PERCUTANEOUS LEAD

  • Print
  • Share
  • E-mail
-
Super Search Devices@FDA
510(k) | DeNovo | Registration & Listing | Adverse Events | Recalls | PMA | HDE | Classification | Standards
CFR Title 21 | Radiation-Emitting Products | X-Ray Assembler | Medsun Reports | CLIA | TPLC
 

ST. JUDE MEDICAL - NEUROMODULATION (PUERTO RICO, LLC) OCTRODE LEAD KIT, 60CM LENGTH; PERCUTANEOUS LEAD Back to Search Results
Model Number 3186
Device Problem Adverse Event Without Identified Device or Use Problem (2993)
Patient Problem Skin Erosion (2075)
Event Date 06/09/2020
Event Type  Injury  
Event Description
Related manufacturer reference number: 3006705815-2020-02381.It was reported the patient's lead was eroding through.Surgical intervention on (b)(6) 2020 found no erosion but there was a lead loop pushing up under the patients skin at the insertion site.Physician was able to bury the loop deeper and anchor it place to address the issue.
 
Event Description
Additional information indicates the system was explanted.
 
Manufacturer Narrative
Correction: section h6 - method code should have been 4117 rather than 4114.
 
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.
 
Search Alerts/Recalls

  New Search  |  Submit an Adverse Event Report

Brand Name
OCTRODE LEAD KIT, 60CM LENGTH
Type of Device
PERCUTANEOUS LEAD
Manufacturer (Section D)
ST. JUDE MEDICAL - NEUROMODULATION (PUERTO RICO, LLC)
lot a interior - #2 street km 67.5
santana industrial park
arecibo PR 00612
MDR Report Key10176799
MDR Text Key195946355
Report Number3006705815-2020-02380
Device Sequence Number1
Product Code LGW
UDI-Device Identifier05415067017246
UDI-Public05415067017246
Combination Product (y/n)N
PMA/PMN Number
P010032
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,consum
Type of Report Initial,Followup,Followup,Followup
Report Date 08/11/2020
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 Date05/07/2021
Device Model Number3186
Device Catalogue Number3186
Device Lot NumberA000079774
Was Device Available for Evaluation? No
Was the Report Sent to FDA? No
Initial Date Manufacturer Received 06/09/2020
Initial Date FDA Received06/19/2020
Supplement Dates Manufacturer Received07/08/2020
07/15/2020
08/09/2020
Supplement Dates FDA Received07/10/2020
07/30/2020
08/11/2020
Is This a Reprocessed and Reused Single-Use Device? No
Patient Sequence Number1
Treatment
MODEL # 3186 - LEAD.; MODEL # 3186 - LEAD
Patient Outcome(s) Other;
Patient Age38 YR
Patient Weight73
-
-