FDA Adverse Event Injury Summary report: N

REACTIV8

MDR report key: 20276713 · Received September 23, 2024

Report

Report Number
3013017877-2024-00071
Event Type
Injury
Date Received
September 23, 2024
Date of Event
August 27, 2024
Report Date
December 30, 2024
Manufacturer
MAINSTAY MEDICAL LIMITED
Product Code
QLK
UDI-DI
05391527770015
PMA / PMN Number
P190021
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
UK
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

MML REFERENCE #: (B)(4). OTHER DEVICE EXPLANTED: MODEL: 8145. DESCRIPTION: PERCUTANEOUS STIMULATION LEADS. SERIAL NUMBERS: (B)(6). UDI: (B)(4).

Additional Manufacturer Narrative · 0

MML REFERENCE #: (B)(4). OTHER DEVICE EXPLANTED: MODEL: 8145 DESCRIPTION: PERCUTANEOUS STIMULATION LEADS SERIAL NUMBERS: (B)(6). UDI: (B)(6). THE DEVICE WAS RETURNED AND EVALUATED. THERE WAS NO ALLEGATION AGAINST THE FUNCTIONALITY OF THE IPG AND LEADS. THE IPG PASSED FUNCTIONAL TESTING AND OPERATED WITHIN THE MANUFACTURING SPECIFICATIONS. NO FUNCTIONAL TESTING COULD BE PERFORMED ON BOTH LEADS BECAUSE THEY WERE RECEIVED IN TWO SEGMENTS. A VISUAL INSPECTION WAS PERFORMED. NO RELEVANT NON-CONFORMANCES WERE FOUND THAT WOULD HAVE CONTRIBUTED TO THE INFECTION. ALTHOUGH REQUESTED, THE RESULT OF THE PATHOLOGY TESTING WAS NOT PROVIDED TO MML. UPDATED B5, H6, AND IPG UDI. UPDATED THE INITIAL REPORTER'S NAME, AND DUE TO GENERAL DATA PROTECTION REGULATIONS IN THE UK, NO PATIENT INFORMATION IS AVAILABLE.

Additional Manufacturer Narrative · 0

MML REFERENCE #: (B)(4). OTHER DEVICE EXPLANTED: MODEL: 8145. DESCRIPTION: PERCUTANEOUS STIMULATION LEADS. SERIAL NUMBERS: (B)(6). UDI: (B)(4). THE DEVICE WAS RETURNED AND EVALUATED. THERE WAS NO ALLEGATION AGAINST THE FUNCTIONALITY OF THE IPG AND LEADS. THE IPG PASSED FUNCTIONAL TESTING AND OPERATED WITHIN THE MANUFACTURING SPECIFICATIONS. NO FUNCTIONAL TESTING COULD BE PERFORMED ON BOTH LEADS BECAUSE THEY WERE RECEIVED IN TWO SEGMENTS. A VISUAL INSPECTION WAS PERFORMED. NO RELEVANT NON-CONFORMANCES WERE FOUND THAT WOULD HAVE CONTRIBUTED TO THE INFECTION. ALTHOUGH REQUESTED, THE RESULT OF THE PATHOLOGY TESTING WAS NOT PROVIDED TO MML.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT HAD A POSITIVE RESPONSE TO THE THERAPY BUT HAD A RASH AND SWELLING AROUND THE IMPLANTABLE PULSE GENERATOR (IPG) SITE. THE PATIENT WAS TREATED WITH ANTIBIOTICS, BUT THE ISSUE PERSISTED, AND THEREFORE, THE PATIENT WAS SCHEDULED TO UNDERGO AN EXPLANT PROCEDURE DUE TO A SUSPECTED ALLERGIC REACTION TO THE DEVICE. DURING THE EXPLANT PROCEDURE, THE PHYSICIAN CONFIRMED IT WAS AN INFECTION, NOT AN ALLERGIC REACTION TO THE DEVICE. THE DEVICE WAS EXPLANTED WITHOUT COMPLICATIONS, AND THE PATIENT WAS ALSO TREATED WITH DIRECT ANTIBIOTICS. THE RESULT OF THE PATHOLOGY TEST IS PENDING. THE DEVICE MANUFACTURING RECORD WAS REVIEWED. NO NON-CONFORMANCES WERE FOUND THAT WOULD HAVE CONTRIBUTED TO THE INFECTION EXPERIENCED BY THE PATIENT.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT HAD A POSITIVE RESPONSE TO THE THERAPY BUT HAD A RASH AND SWELLING AROUND THE IMPLANTABLE PULSE GENERATOR (IPG) SITE. THE PATIENT WAS TREATED WITH ANTIBIOTICS, BUT THE ISSUE PERSISTED, AND THEREFORE, THE PATIENT WAS SCHEDULED TO UNDERGO AN EXPLANT PROCEDURE DUE TO A SUSPECTED ALLERGIC REACTION TO THE DEVICE. DURING THE EXPLANT PROCEDURE, THE PHYSICIAN CONFIRMED IT WAS AN INFECTION, NOT AN ALLERGIC REACTION TO THE DEVICE. THE DEVICE WAS EXPLANTED WITHOUT COMPLICATIONS, AND THE PATIENT WAS ALSO TREATED WITH DIRECT ANTIBIOTICS. THE DEVICE MANUFACTURING AND STERILIZATION RECORD WAS REVIEWED. NO NON-CONFORMANCES WERE FOUND THAT WOULD HAVE CONTRIBUTED TO THE INFECTION EXPERIENCED BY THE PATIENT.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT HAD A POSITIVE RESPONSE TO THE THERAPY BUT HAD A RASH AND SWELLING AROUND THE IMPLANTABLE PULSE GENERATOR (IPG) SITE. THE PATIENT WAS TREATED WITH ANTIBIOTICS, BUT THE ISSUE PERSISTED, AND THEREFORE, THE PATIENT WAS SCHEDULED TO UNDERGO AN EXPLANT PROCEDURE DUE TO A SUSPECTED ALLERGIC REACTION TO THE DEVICE. DURING THE EXPLANT PROCEDURE, THE PHYSICIAN CONFIRMED IT WAS AN INFECTION, NOT AN ALLERGIC REACTION TO THE DEVICE. THE DEVICE WAS EXPLANTED WITHOUT COMPLICATIONS, AND THE PATIENT WAS ALSO TREATED WITH DIRECT ANTIBIOTICS. THE DEVICE MANUFACTURING AND STERILIZATION RECORD WAS REVIEWED. NO NON-CONFORMANCES WERE FOUND THAT WOULD HAVE CONTRIBUTED TO THE INFECTION EXPERIENCED BY THE PATIENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1784720 REACTIV8 REACTIV8 IMPLANTABLE PULSE GENERATOR QLK MAINSTAY MEDICAL LIMITED 5100 05391527770015

Patients

Seq Age Sex Outcome Treatment
1 NA Female Other