FDA Adverse Event Malfunction Summary report: N

PRECISION®

MDR report key: 3073565 · Received April 23, 2013

Report

Report Number
3006630150-2013-00789
Event Type
Malfunction
Date Received
April 23, 2013
Date of Event
March 12, 2013
Report Date
March 22, 2013
Manufacturer
BOSTON SCIENTIFIC NEUROMODULATION
Product Code
LGW
PMA / PMN Number
030017
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CA, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

DEVICE EVALUATION INDICATED THAT THE IPG PASSED VISUAL, ELECTRICAL, PERFORMANCE AND PHOTOGRAPHIC IMAGING TESTS PERFORMED. THE COMPLAINT WAS NOT VERIFIED. UPON RECEIVING, THE IPG WAS IN HIBERNATION. IN THE LAB, THE IPG WAS CHARGED IN TWO CHARGING CYCLES. THE CHARGE PROFILE REVEALED NO ANOMALIES. BATTERY DEPLETION RATE AND SLEEP CURRENT RATE OF THE DEVICE WERE WITHIN THE EXPECTED RANGES. THE DEVICE PASSED ALL REQUIRED TESTS. THE DEVICE EXHIBITS NORMAL DEVICE CHARACTERISTICS.

Additional Manufacturer Narrative · 1

ADDITIONAL INFORMATION WAS RECEIVED THAT THE PATIENT UNDERWENT AN IPG REPLACEMENT. THE PATIENT WAS DOING WELL FOLLOWING THE PROCEDURE.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT¿S IPG WAS UNRESPONSIVE. THE IPG WOULD NOT CONNECT TO THE REMOTE CONTROL (RC), IT WOULD NOT CHARGE AND THE RC WAS SHOWING ERROR CODE 8000. THE PATIENT WILL UNDERGO A POCKET REVISION.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT'S IPG WAS UNRESPONSIVE. THE IPG WOULD NOT CONNECT TO THE REMOTE CONTROL (RC), IT WOULD NOT CHARGE AND THE RC WAS SHOWING ERROR CODE 8000. THE PATIENT WILL UNDERGO A POCKET REVISION.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT¿S IPG WAS UNRESPONSIVE. THE IPG WOULD NOT CONNECT TO THE REMOTE CONTROL (RC), IT WOULD NOT CHARGE AND THE RC WAS SHOWING ERROR CODE 8000. THE PATIENT WILL UNDERGO A POCKET REVISION.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
174687 PRECISION® SPINAL CORD STIMULATOR LGW BOSTON SCIENTIFIC NEUROMODULATION SC-1110 NA

Patients

Seq Age Sex Outcome Treatment
1 70 YR