FDA Adverse Event Injury Summary report: N

WAVEWRITER ALPHA

MDR report key: 15048969 · Received July 18, 2022

Report

Report Number
3006630150-2022-03522
Event Type
Injury
Date Received
July 18, 2022
Date of Event
June 7, 2022
Report Date
September 29, 2022
Manufacturer
BOSTON SCIENTIFIC NEUROMODULATION
Product Code
LGW
UDI-DI
08714729985099
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
CO, US
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

EXACT DATE UNKNOWN, EVENT OCCURRED A FEW WEEKS AFTER THE IMPLANT DATE.

Additional Manufacturer Narrative · 0

ADDITIONAL SUSPECT MEDICAL DEVICE COMPONENT INVOLVED IN THE EVENT: PRODUCT FAMILY: SCS-ADAPTERS. UPN: M365SC9208150 . MODEL: SC-9208-15. SERIAL: (B)(6). BATCH: 7071553.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT DEVELOPED AN INFECTION AT THE IPG SITE. DRAINAGE FROM THE IPG INCISION SITE WAS NOTED. THE PHYSICIAN BELIEVED THAT THE INFECTION WAS NOT PROCEDURE RELATED AND THE CAUSE WAS UNKNOWN. THE PATIENT WAS PLACED ON ANTIBIOTICS. THE PATIENT WAS HOSPITALIZED AND THE IPG POCKET WAS WASHED OUT.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT DEVELOPED AN INFECTION AT THE IPG SITE. DRAINAGE FROM THE IPG INCISION SITE WAS NOTED. THE PHYSICIAN BELIEVED THAT THE INFECTION WAS NOT PROCEDURE RELATED AND THE CAUSE WAS UNKNOWN. THE PATIENT WAS PLACED ON ANTIBIOTICS. THE PATIENT WAS HOSPITALIZED AND THE IPG POCKET WAS WASHED OUT. ADDITIONAL INFORMATION WAS RECEIVED THAT ALL COMPONENTS WERE EXPLANTED AND WILL NOT BE RETURNED PER HOSPITAL POLICY. THE PATIENT WAS DOING WELL POSTOPERATIVELY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
333644 WAVEWRITER ALPHA STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF LGW BOSTON SCIENTIFIC NEUROMODULATION SC-1232 537884 08714729985099

Patients

Seq Age Sex Outcome Treatment
1 23 YR Female Hospitalization| R