FDA Adverse Event Injury Summary report: N

PRECISION®

MDR report key: 2760030 · Received September 26, 2012

Report

Report Number
3006630150-2012-01803
Event Type
Injury
Date Received
September 26, 2012
Date of Event
March 23, 2012
Report Date
September 4, 2012
Manufacturer
BOSTON SCIENTIFIC NEUROMODULATION
Product Code
LGW
PMA / PMN Number
030017
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
FL, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

ADDITIONAL INFORMATION WAS RECEIVED THAT THE PHYSICIAN INDICATED THAT THE ITCHING WAS NOT DEVICE RELATED.

Additional Manufacturer Narrative · 1

ADDITIONAL SUSPECT MEDICAL DEVICE COMPONENTS INVOLVED IN THE EVENT: MODEL #: SC-8216-70, SERIAL #: (B)(4), DESCRIPTION: ARTISAN SURGICAL LEAD, 70CM.

Additional Manufacturer Narrative · 1

DEVICE EVALUATION INDICATED THAT THE IPG PASSED VISUAL,OPERATIONAL AND PHOTOGRAPHIC IMAGING TESTS PERFORMED. BASED ON THE BATTERY AND CHARGE PROFILES, IT APPEARS THAT THE DEVICE EXHIBITS NORMAL CHARACTERISTICS PRIOR THE EXPLANT PROCEDURE. IT WAS REPORTED THAT ELECTROCAUTERY WAS USED DURING THE EXPLANT PROCEDURE. THE AIC WAS DAMAGED AND IT RESULTED IN THE RAPID BATTERY DEPLETION POST EXPLANT. THE MONOPOLAR ELECTROCAUTERY PROCEDURES ARE A KNOWN SOURCE OF HIGH-VOLTAGE TRANSIENT SIGNAL THAT CAN DAMAGE THE AIC-U1. DEVICE EVALUATION INDICATED THAT THE LEAD WAS DAMAGED AND IS CONSISTENT WITH DAMAGES DONE DURING THE EXPLANT PROCEDURE AND ARE NOT CONSIDERED A FAILURE.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT WAS EXPLANTED DUE TO ITCHING ON HER ARMS AND LEGS.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT WAS EXPLANTED DUE TO ITCHING ON HER ARMS AND LEGS.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT WAS EXPLANTED DUE TO ITCHING ON HER ARMS AND LEGS.

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 53 YR Required Intervention