FDA Adverse Event Injury Summary report: N

QUATTRODE LEAD WIDE SPACED, 90 CM

MDR report key: 22558310 · Received July 21, 2025

Report

Report Number
1627487-2025-03562
Event Type
Injury
Date Received
July 21, 2025
Date of Event
June 9, 2025
Report Date
September 23, 2025
Manufacturer
ABBOTT MEDICAL
Product Code
LGW
UDI-DI
05414734406116
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
MI, US
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

DATE OF EVENT IS ESTIMATED. ADDITIONAL COMPONENTS POTENTIALLY INVOLVED IN THE EVENT INCLUDE: COMMON DEVICE NAME: QUATTRODE, MODEL: 3169, UDI: (B)(4), SERIAL: (B)(6), BATCH: 6042358.

Additional Manufacturer Narrative · 0

THE RESULTS OF THE INVESTIGATION ARE INCONCLUSIVE SINCE THE DEVICE WAS NOT RETURNED FOR ANALYSIS. BASED ON THE INFORMATION RECEIVED, THE CAUSE OF THE REPORTED EVENT COULD NOT BE CONCLUSIVELY DETERMINED.

Additional Manufacturer Narrative · 0

THE RESULTS OF THE INVESTIGATION ARE INCONCLUSIVE SINCE THE DEVICE WAS NOT RETURNED FOR ANALYSIS. BASED ON THE INFORMATION RECEIVED, THE CAUSE OF THE REPORTED EVENT COULD NOT BE CONCLUSIVELY DETERMINED.

Description of Event or Problem · 0

IT WAS REPORTED THE PATIENT'S LEFT OCCIPITAL LEAD HAD HIGH IMPEDANCES. SURGICAL INTERVENTION MAY BE PENDING TO ADDRESS THE ISSUE. NOTE : IT IS UNKNOWN WHICH LEAD IS RELATED TO THIS ISSUE.

Description of Event or Problem · 0

ADDITIONAL INFORMATION RECEIVED INDICATES THE PATIENT HAD INEFFECTIVE THERAPY DUE TO BOTH OCCIPITAL LEADS HAD HIGH IMPEDANCE. SURGICAL INTERVENTION TOOK PLACE WHEREIN THE LEADS WERE EXPLANTED AND REPLACED. EFFECTIVE THERAPY RESTORED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2732070 QUATTRODE LEAD WIDE SPACED, 90 CM SCS LEAD LGW ABBOTT MEDICAL 3169 6042358 05414734406116

Patients

Seq Age Sex Outcome Treatment
1 NA Female Other SCS ADAPTERX2.| SCS ANCHORX2.| SCS IPG.| SCS LEADX3.