FDA Adverse Event
Injury
Summary report: N
FISHER WALLACE CRANIAL NEUROSTIMULATOR
MDR report key: 16862298
·
Received May 3, 2023
Report
- Report Number
- 3006258094-2023-00006
- Event Type
- Injury
- Date Received
- May 3, 2023
- Report Date
- September 15, 2022
- Manufacturer
- FISHER WALLACE LABS.
- Product Code
- QJQ
- PMA / PMN Number
- K903654
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- US
- Reporter Occupation
- 003
Narratives
Description of Event or Problem · 0
EXPERIENCED SIGNIFICANT ADVERSE EFFECTS AFTER USING THE DEVICE SUCH AS HEADACHES, IRRITABILITY, EMOTIONALLY UNSTABLE, TEMPORAL MEMORY/CONCENTRATION ISSUE.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 714268 | FISHER WALLACE CRANIAL NEUROSTIMULATOR | CRANIAL NEUROSTIMULATOR | QJQ | FISHER WALLACE LABS. | FW-100 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Female | Other |