| Brand Name | Proclaim¿ 5 Elite Implantable Pulse Generator |
| Common Device Name | Stimulator, Spinal-Cord, Totally Implanted For Pain Relief |
| Manufacturer (Section D) |
| St. Jude Medical - Neuromodulation (Puerto Rico, LLC) |
| lot a interior - #2 street km 67.5 |
| santana industrial park |
| arecibo PR 00612 |
|
| Manufacturer (Section G) |
| St. Jude Medical - Neuromodulation (Puerto Rico, LLC) |
| lot a interior - #2 street km 67.5 |
| santana industrial park |
| arecibo PR 00612 |
|
| Manufacturer Contact |
|
sara
speyerer
|
| 6901 preston road |
| plano, TX 75024
|
|
+1(972)309-8000
|
|
| MDR Report Key | 50104335 |
| Report Number | 3006705815-2026-04789 |
| Device Sequence Number | 12075851 |
| Product Code |
LGW
|
| UDI-Device Identifier | 05415067020192 |
| UDI-Public | (01)05415067020192(10)A000061861(17)200711 |
| Combination Product (Y/N) | N |
| Initial Reporter State | GA |
| Initial Reporter Country | US |
| PMA/510(K) Number | P010032 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2018 |
| Device Explanted Year | 2026 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,Company Representative |
| Initial Reporter Occupation |
Physician
|
| Remedial Action |
Other,Recall,Notification |
| Type of Report
| Initial,Followup,Followup |
| Report Date (Section B) |
09/24/2026 |
| 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? |
Yes
|
| Operator of Device |
Health Professional
|
| Device Expiration Date | 07/11/2020 |
| Device Model Number | 3660 |
| Device Catalogue Number | 3660 |
| Device Lot Number | A000061861 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
No
|
| Was the Report Sent to FDA? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 07/07/2026 |
| Supplement Date Received by Manufacturer | 09/16/2026 09/16/2026
|
| Initial Report FDA Received Date | 07/31/2026 |
| Supplement Report FDA Received Date | 09/16/2026 09/24/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 07/12/2018 |
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Initial
|
If action reported to FDA under 21 USC 360i(g), list FDA-assigned Recall Number or include a statement | 1627487-04/02/26-001-C |
| Patient Sequence Number | 1 |
Concomitant Medical Products and Therapy/Usage Dates | SCS ANCHOR (x2); SCS LEAD (x2) |
| Outcome Attributed to Adverse Event |
Other;
|
| Patient Sex | Female |
| Patient Weight | 150 LB |