FDA Adverse Event
Injury
Summary report: N
LINEAR ST
MDR report key: 13619384
·
Received February 28, 2022
Report
- Report Number
- 3006630150-2022-00731
- Event Type
- Injury
- Date Received
- February 28, 2022
- Date of Event
- January 21, 2022
- Report Date
- February 28, 2022
- Manufacturer
- BOSTON SCIENTIFIC NEUROMODULATION
- Product Code
- LGW
- UDI-DI
- 08714729767725
- PMA / PMN Number
- P030017
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- TN, US
- Reporter Occupation
- PHYSICIAN
- Health Professional
- Yes
Narratives
Additional Manufacturer Narrative · 0
DATE OF EVENT: APPROXIMATED BASED ON THE DATE THE MANUFACTURER BECAME AWARE OF THE EVENT. ADDITIONAL SUSPECT MEDICAL DEVICE COMPONENT INVOLVED IN THE EVENT: PRODUCT FAMILY: SCS-LINEAR LEADS, UPN: M365SC2218500, MODEL: SC-2218-50, SERIAL: (B)(4), BATCH: 7092527.
Description of Event or Problem · 0
IT WAS REPORTED THAT THE PATIENTS LEADS HAD MIGRATED. REPROGRAMMING WAS PERFORMED AND APPEARED TO BE SUCCESSFUL. THE PATIENT UNDERWENT A REVISION PROCEDURE WHEREIN THE LEADS WERE ADJUSTED BACK TO APPROPRIATE LEVEL AND REMAINED IMPLANTED IN PATIENTS BODY.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 685618 | LINEAR ST | STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF | LGW | BOSTON SCIENTIFIC NEUROMODULATION | SC-2218-50 | 7092473 | 08714729767725 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 58 YR | Female | Required Intervention |