BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SPECTRA WAVEWRITER

    MDR report key: 10778805 · Received November 3, 2020

    Report

    Report Number
    3006630150-2020-05321
    Event Type
    Injury
    Date Received
    November 3, 2020
    Date of Event
    October 16, 2020
    Report Date
    November 3, 2020
    Manufacturer
    BOSTON SCIENTIFIC NEUROMODULATION
    Product Code
    LGW
    UDI-DI
    08714729951254
    PMA / PMN Number
    P030017
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    APPROXIMATED BASED ON THE DATE THE MANUFACTURER BECAME AWARE OF THE EVENT. ADDITIONAL SUSPECT MEDICAL DEVICE COMPONENTS INVOLVED IN THE EVENT: PRODUCT FAMILY: SCS-LINEAR LEADS, UPN: (B)(4), MODEL: SC-2218-50, SERIAL: (B)(4), BATCH: 5137726/7070473.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT DID NOT LIKE THE STIMULATION. THE PATIENT UNDERWENT A SYSTEM EXPLANT PROCEDURE AND DEVICES WILL NOT BE RETURNED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1246180 SPECTRA WAVEWRITER STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF LGW BOSTON SCIENTIFIC NEUROMODULATION SC-1160 365844 08714729951254

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Required Intervention