BEUDAMED
    FDA Adverse Event Injury Summary report: N

    FISHER WALLACE CRANIAL NEUROSTIMULATOR

    MDR report key: 16863091 · Received May 3, 2023

    Report

    Report Number
    3006258094-2023-00005
    Event Type
    Injury
    Date Received
    May 3, 2023
    Date of Event
    April 28, 2022
    Report Date
    April 29, 2022
    Manufacturer
    FISHER WALLACE LABS
    Product Code
    QJQ
    PMA / PMN Number
    K903654
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    003

    Narratives

    Description of Event or Problem · 0

    DEVICE CAUSED DEMENTIA IN THE SPAN OF A WEEK. CONDITION AFTER EVENT: STABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    543867 FISHER WALLACE CRANIAL NEUROSTIMULATOR CRANIAL NEUROSTIMULATOR QJQ FISHER WALLACE LABS FW-100

    Patients

    Seq Age Sex Outcome Treatment
    1 Female Other