FDA Adverse Event Injury Summary report: N

REACTIV8

MDR report key: 19769080 · Received July 18, 2024

Report

Report Number
3013017877-2024-00055
Event Type
Injury
Date Received
July 18, 2024
Date of Event
June 19, 2024
Report Date
September 20, 2024
Manufacturer
MAINSTAY MEDICAL LIMITED
Product Code
QLK
UDI-DI
05391527770015
PMA / PMN Number
P190021
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
NY, US
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

MML REF #: (B)(4). B2-OTHER: PAIN/DISCOMFORT.

Additional Manufacturer Narrative · 0

MML REF #: (B)(4). B2-OTHER: PAIN/DISCOMFORT. PATIENT DEMOGRAPHIC INFORMATION WAS ADDED. NO PART WAS RETURNED FOR EVALUATION; NO DEVICE EVALUATION CAN BE PERFORMED. THE DEVICE MANUFACTURING RECORD WAS REVIEWED. NO RELEVANT NON-CONFORMANCES WERE FOUND. OTHER DEVICES EXPLANTED: MODEL: 8145. DESCRIPTION: PERCUTANEOUS STIMULATION LEADS. SERIAL NUMBERS: B)(6). UDI #: (B)(4).

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT'S PAIN HAD GOTTEN WORSE SINCE THE DEVICE WAS IMPLANTED. MAINSTAY MEDICAL REPRESENTATIVE CONTACTED THE IMPLANTING PHYSICIAN, WHO NOTED THAT THE IMPLANTABLE PULSE GENERATOR (IPG) WAS PRESSING ON THE ILIAC CREST, CAUSING RADICULAR-LIKE SYMPTOMS. AN X-RAY, COMPUTED TOMOGRAPHY (CT) SCAN, AND MAGNETIC RESONANCE IMAGING (MRI) CONFIRMED THIS WAS NOT THE CASE. THE REACTIV8 SYSTEM WAS EXPLANTED. ALL PARTS WERE REMOVED AND INTACT. PER THE HOSPITAL'S PROTOCOL, NO PART IS EXPECTED TO BE RETURNED. REPORTEDLY, THE DEVICE HAS BEEN TURNED OFF FOR A MONTH BEFORE THE EXPLANT PROCEDURE. THERE WAS NO REPORT OF PATIENT HARM OR INJURY.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT'S PAIN HAD GOTTEN WORSE SINCE THE DEVICE WAS IMPLANTED. MAINSTAY MEDICAL REPRESENTATIVE CONTACTED THE IMPLANTING PHYSICIAN, WHO NOTED THAT THE IMPLANTABLE PULSE GENERATOR (IPG) WAS PRESSING ON THE ILIAC CREST, CAUSING RADICULAR-LIKE SYMPTOMS. AN X-RAY, COMPUTED TOMOGRAPHY (CT) SCAN, AND MAGNETIC RESONANCE IMAGING (MRI) CONFIRMED THIS WAS NOT THE CASE. THE REACTIV8 SYSTEM WAS EXPLANTED. ALL PARTS WERE REMOVED AND INTACT. PER THE HOSPITAL'S PROTOCOL, NO PART IS EXPECTED TO BE RETURNED. REPORTEDLY, THE DEVICE HAS BEEN TURNED OFF FOR A MONTH BEFORE THE EXPLANT PROCEDURE. THERE WAS NO REPORT OF PATIENT HARM OR INJURY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2150137 REACTIV8 REACTIV8 IMPLANTABLE PULSE GENERATOR QLK MAINSTAY MEDICAL LIMITED 5100 05391527770015

Patients

Seq Age Sex Outcome Treatment
1 67 YR Male Other