FDA Adverse Event Injury Summary report: N

PRECISION®

MDR report key: 2080352 · Received May 6, 2011

Report

Report Number
3006630150-2011-00656
Event Type
Injury
Date Received
May 6, 2011
Report Date
April 12, 2011
Manufacturer
BOSTON SCIENTIFIC NEUROMODULATION
Product Code
LGW
PMA / PMN Number
030017
Removal / Correction Number
NA
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
PA, US
Reporter Occupation
HEALTH PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 1

THE IPG PASSED VISUAL INSPECTION. THE COMPLAINT OF DAMAGE TO THE IPG BECAUSE OF CARDIOVERSION PROCEDURE HAS BEEN CONFIRMED. THE ANALOG IC ((B)(4)) WAS DAMAGED. THE BATTERY DEPLETION RATE WITH STIMULATION OFF EXCEEDED THE TYPICAL BATTERY DEPLETION RATE. ALSO, THE DEVICE FAILED THE IMPEDANCE PORTION OF THE AUTOMATED TEST EQUIPMENT. DEPLETION RATE IS IN THE NORMAL RANGE PRIOR TO THE PATIENT'S CARDIOVERSION. AT THE APPROXIMATE DATE OF THE PROCEDURE, THE DEPLETION RATE CLIMBS MARKEDLY. THE (B)(4) DAMAGE RESULTED IN THE RAPID BATTERY DEPLETION RATE OF THE IPG. THE USE OF CARDIOVERSION RESULTED IN THE REPORTED COMPLAINT.

Additional Manufacturer Narrative · 1

(B)(6).

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT A PATIENT WAS HAVING DIFFICULTIES MAINTAINING A FULL CHARGE ON HER IPG. DURING TROUBLESHOOTING, THE BSN REPRESENTATIVE DETERMINED THAT THE IPG MAYBE DAMAGED FROM A CARDIOVERSION PROCEDURE. THE PHYSICIAN REPLACED THE IPG AND THE PATIENT IS REPORTEDLY DOING WELL FOLLOWING THE PROCEDURE.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT A PATIENT WAS HAVING DIFFICULTIES MAINTAINING A FULL CHARGE ON HER IPG. DURING TROUBLESHOOTING, THE BSN REPRESENTATIVE DETERMINED THAT THE IPG MAYBE DAMAGED FROM A CARDIOVERSION PROCEDURE. THE PHYSICIAN REPLACED THE IPG AND THE PATIENT IS REPORTEDLY DOING WELL FOLLOWING THE PROCEDURE.

Devices

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

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention