FDA Adverse Event Injury Summary report: N

PRECISION®

MDR report key: 3243635 · Received July 23, 2013

Report

Report Number
3006630150-2013-01533
Event Type
Injury
Date Received
July 23, 2013
Date of Event
March 26, 2013
Report Date
March 26, 2013
Manufacturer
BOSTON SCIENTIFIC NEUROMODULATION
Product Code
LGW
PMA / PMN Number
030017
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
AZ, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

ADDITIONAL INFORMATION WAS RECEIVED THAT THE PATIENT UNDERWENT A REVISION PROCEDURE WHEREIN THE IPG WAS REPLACED. NO DEVICE MALFUNCTION WAS SUSPECTED. THE PATIENT WAS REPORTEDLY DOING WELL POSTOPERATIVELY. THE EXPLANTED DEVICE WAS NOT RETURNED TO BSN AS IT WAS DISCARDED BY THE MEDICAL FACILITY.

Additional Manufacturer Narrative · 1

ADDITIONAL INFORMATION WAS RECEIVED THAT NO FURTHER COURSE OF ACTION WILL BE TAKEN AT THIS TIME.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT'S IPG WOULD NOT CHARGE AND WOULD NOT COMMUNICATE WITH THE REMOTE CONTROL. THE PATIENT WAS ALSO EXPERIENCING DISCOMFORT AT THE POCKET SITE. X-RAY CONFIRMED THAT THE IPG FLIPPED. THE PATIENT WILL UNDERGO REVISION PROCEDURE.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT'S IPG WOULD NOT CHARGE AND WOULD NOT COMMUNICATE WITH THE REMOTE CONTROL. THE PATIENT WAS ALSO EXPERIENCING DISCOMFORT AT THE POCKET SITE. X-RAY CONFIRMED THAT THE IPG FLIPPED. THE PATIENT WILL UNDERGO REVISION PROCEDURE.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT'S IPG WOULD NOT CHARGE AND WOULD NOT COMMUNICATE WITH THE REMOTE CONTROL. THE PATIENT WAS ALSO EXPERIENCING DISCOMFORT AT THE POCKET SITE. X-RAY CONFIRMED THAT THE IPG FLIPPED. THE PATIENT WILL UNDERGO REVISION PROCEDURE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
343716 PRECISION® SPINAL CORD STIMULATOR LGW BOSTON SCIENTIFIC NEUROMODULATION SC-1110-02 NA

Patients

Seq Age Sex Outcome Treatment
1 47 YR Required Intervention