FDA Adverse Event Injury Summary report: N

PRECISION®

MDR report key: 2072900 · Received April 29, 2011

Report

Report Number
3006630150-2011-00626
Event Type
Injury
Date Received
April 29, 2011
Date of Event
April 5, 2011
Report Date
April 5, 2011
Manufacturer
BOSTON SCIENTIFIC NEUROMODULATION
Product Code
LGW
PMA / PMN Number
030017
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
SC, US
Reporter Occupation
HEALTH PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 1

ADDITIONAL INFORMATION WAS RECEIVED THAT THE PATIENT UNDERWENT THE POCKET REVISION AND WAS REPORTEDLY DOING WELL FOLLOWING THE PROCEDURE. A REVIEW OF THE MANUFACTURING DOCUMENTATION FOR THE IPG REVEALED THAT NO ANOMALIES OR DEVIATIONS POTENTIALLY RELATED TO THE EVENT OCCURRED DURING MANUFACTURING.

Additional Manufacturer Narrative · 1

ADDITIONAL INFORMATION WAS RECEIVED THAT THE POCKET REVISION WAS PUT ON HOLD AS THE PATIENT WAS GIVEN LIDODERM PATCHES TO TEST FOR THREE WEEKS. THE NEXT COURSE OF ACTION REGARDING THE REVISION WILL BE MADE AFTER THE THREE WEEK TRIAL OF THE PAIN PATCHES.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT WILL UNDERGO A POCKET REVISION DUE TO PAIN AT THE POCKET SITE CAUSED BY THE IPG MIGRATING TOWARDS THE SKIN.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT WILL UNDERGO A POCKET REVISION DUE TO PAIN AT THE POCKET SITE CAUSED BY THE IPG MIGRATING TOWARDS THE SKIN.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT WILL UNDERGO A POCKET REVISION DUE TO PAIN AT THE POCKET SITE CAUSED BY THE IPG MIGRATING TOWARDS THE SKIN.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 PRECISION® SPINAL CORD STIMULATOR LGW BOSTON SCIENTIFIC NEUROMODULATION SC-1110-02 N/A

Patients

Seq Age Sex Outcome Treatment
1 43 YR Required Intervention