BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PRECISION

    MDR report key: 1833370 · Received September 9, 2010

    Report

    Report Number
    3006630150-2010-01556
    Event Type
    Injury
    Date Received
    September 9, 2010
    Date of Event
    August 10, 2010
    Report Date
    August 10, 2010
    Manufacturer
    BOSTON SCIENTIFIC NEUROMODULATION
    Product Code
    LGW
    PMA / PMN Number
    P030017
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    A REPORT WAS RECEIVED THAT THE PT WAS EXPLANTED DUE TO A BURNING SENSATION AT THE IPG SITE AND A BURNING PAIN AT THE LEADS. THE PT IS DOING WELL FOLLOWING THE EXPLANT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PRECISION SPINAL CORD STIMULATOR LGW BOSTON SCIENTIFIC NEUROMODULATION SC-1110 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 58 YR Required Intervention ST LEAD, 50 CM:| MODEL#: SC-2138-50 , SERIAL#: (B)(4)| SERIAL#: (B)(4)