MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2020-03-26 for PROCLAIM? DRG IMPLANTABLE PULSE GENERATOR 3664 manufactured by St. Jude Medical - Neuromodulation.
[185141453]
Date of event is estimated. The results/method and conclusion codes along with investigation results will be provided in the final report.
Patient Sequence No: 1, Text Type: N, H10
[185141454]
Related manufacturer reference# 1627487-2020-03106, 1627487-2020-03107, & 1627487-2020-03109. It was reported that the patient experienced ineffective therapy. Troubleshooting revealed high impedances on some of the contacts. As a result, surgical intervention was undertaken on (b)(6) 2020 wherein the ipg and 1 lead at t9 was explanted. Reportedly, the remaining two leads were cut and a portion of the leads remain implanted (related manufacturer reference# 1627487-2020-03112, 1627487-2020-03113, & 1627487-2020-03114 ). Note: both t9 leads are being reported because it's unknown which lead was explanted.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1627487-2020-03110 |
| MDR Report Key | 9883217 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2020-03-26 |
| Date of Report | 2020-03-26 |
| Date of Event | 2020-03-10 |
| Date Mfgr Received | 2020-03-10 |
| Device Manufacturer Date | 2019-02-22 |
| Date Added to Maude | 2020-03-26 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | ANDREA DEITZ |
| Manufacturer Street | 6901 PRESTON ROAD |
| Manufacturer City | PLANO TX 75024 |
| Manufacturer Country | US |
| Manufacturer Postal | 75024 |
| Manufacturer Phone | 9723098000 |
| Manufacturer G1 | ST. JUDE MEDICAL - NEUROMODULATION |
| Manufacturer Street | 6901 PRESTON RD |
| Manufacturer City | PLANO TX 75024 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 75024 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | PROCLAIM? DRG IMPLANTABLE PULSE GENERATOR |
| Generic Name | DRG IPG |
| Product Code | PMP |
| Date Received | 2020-03-26 |
| Model Number | 3664 |
| Catalog Number | 3664 |
| Lot Number | 6865506 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ST. JUDE MEDICAL - NEUROMODULATION |
| Manufacturer Address | 6901 PRESTON RD PLANO TX 75024 US 75024 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2020-03-26 |