BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LINEAR ST

    MDR report key: 14697347 · Received June 15, 2022

    Report

    Report Number
    3006630150-2022-02891
    Event Type
    Injury
    Date Received
    June 15, 2022
    Date of Event
    April 19, 2022
    Report Date
    June 15, 2022
    Manufacturer
    BOSTON SCIENTIFIC NEUROMODULATION
    Product Code
    LGW
    UDI-DI
    08714729767725
    PMA / PMN Number
    P030017
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AL, US
    Reporter Occupation
    PHYSICIAN
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    ADDITIONAL SUSPECT MEDICAL DEVICE COMPONENT INVOLVED IN THE EVENT: PRODUCT FAMILY: SCS-LINEAR LEADS, UPN: M365SC2218500, MODEL: SC-2218-50, SERIAL: (B)(4), BATCH: 7100626.

    Description of Event or Problem · 0

    IT WAS REPORTED THE PATIENT WAS EXPERIENCING INADEQUATE STIMULATION DESPITE REPROGRAMMING DONE. AN X-RAY WAS TAKEN AND REVEALED LEAD MIGRATION. THE PATIENT UNDERWENT A REVISION PROCEDURE WHEREIN A LEAD WAS ADDED. THE PATIENT WAS DOING WELL POSTOPERATIVELY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2869063 LINEAR ST STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF LGW BOSTON SCIENTIFIC NEUROMODULATION SC-2218-50 7099035 08714729767725

    Patients

    Seq Age Sex Outcome Treatment
    1 51 YR Female Required Intervention