FDA Adverse Event
Injury
Summary report: N
LINEAR ST
MDR report key: 17648945
·
Received August 30, 2023
Report
- Report Number
- 3006630150-2023-05170
- Event Type
- Injury
- Date Received
- August 30, 2023
- Date of Event
- May 24, 2023
- Report Date
- August 30, 2023
- Manufacturer
- BOSTON SCIENTIFIC NEUROMODULATION
- Product Code
- LGW
- UDI-DI
- 08714729767725
- PMA / PMN Number
- P030017
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- KY, 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)(6), AND BATCH: 7121471.
Description of Event or Problem · 0
IT WAS REPORTED THAT PATIENT WAS EXPERIENCING A WORSENING PAIN. THE PATIENT HAS AN INADEQUATE STIMULATION DESPITE A REPROGRAMMING ATTEMPT. X-RAY SHOWED THAT THE LEADS HAD MOVED, AND THE CONTACTS WERE OUT. THE PATIENT WAS PRESCRIBED WITH MEDICATIONS.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1417086 | LINEAR ST | STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF | LGW | BOSTON SCIENTIFIC NEUROMODULATION | SC-2218-50 | 7121384 | 08714729767725 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 56 YR | Male | Required Intervention |