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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ST. JUDE MEDICAL - NEUROMODULATION PROCLAIM 7 ELITE; SCS IPG

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ST. JUDE MEDICAL - NEUROMODULATION PROCLAIM 7 ELITE; SCS IPG Back to Search Results
Model Number 3662
Device Problem Application Program Freezes, Becomes Nonfunctional (4031)
Patient Problem Inadequate Pain Relief (2388)
Event Date 04/30/2019
Event Type  Injury  
Manufacturer Narrative
The device is included in the neuromodulation implantable pulse generator (ipg) inoperable when exposed to monopolar electrosurgery advisory notice issued by abbott on 02 june 2017.Date of event is estimated.The investigation results will be provided in the final report.
 
Event Description
It was reported the patient cannot connect to the ipg with external devices following an unrelated surgery.Surgical intervention may be pending to address the issue.
 
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.
 
Event Description
Additional information indicates the ipg was explanted and replaced to address the issue.
 
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Brand Name
PROCLAIM 7 ELITE
Type of Device
SCS IPG
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 Key8753097
MDR Text Key149788567
Report Number1627487-2019-07641
Device Sequence Number1
Product Code LGW
UDI-Device Identifier05415067020222
UDI-Public05415067020222
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
P010032
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,consum
Reporter Occupation Physician
Remedial Action Other
Type of Report Initial,Followup,Followup,Followup,Followup
Report Date 04/02/2020
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? Yes
Device Operator Health Professional
Device Expiration Date11/25/2017
Device Model Number3662
Device Catalogue Number3662
Device Lot Number5304011
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Was the Report Sent to FDA? No
Initial Date Manufacturer Received 06/13/2019
Initial Date FDA Received07/02/2019
Supplement Dates Manufacturer Received08/27/2019
01/07/2020
01/24/2020
03/30/2020
Supplement Dates FDA Received08/28/2019
01/24/2020
01/27/2020
04/02/2020
Was Device Evaluated by Manufacturer? No
Date Device Manufactured11/25/2015
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Removal/Correction Number1627487/06/02/2017/001-C
Patient Sequence Number1
Patient Outcome(s) Other;
Patient Weight73
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