FDA Adverse Event Injury Summary report: N

PRECISION®

MDR report key: 3974013 · Received August 1, 2014

Report

Report Number
3006630150-2014-01751
Event Type
Injury
Date Received
August 1, 2014
Date of Event
May 27, 2014
Report Date
July 10, 2014
Manufacturer
BOSTON SCIENTIFIC NEUROMODULATION
Product Code
LGW
PMA / PMN Number
030017
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
TN, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

ADDITIONAL INFORMATION WAS RECEIVED THAT THE PATIENT UNDERWENT A REVISION PROCEDURE WHEREIN THE IPG WAS RELOCATED. NO DEVICE MALFUNCTION WAS SUSPECTED. THE PATIENT WAS DOING WELL POSTOPERATIVELY.

Additional Manufacturer Narrative · 1

ADDITIONAL INFORMATION WAS RECEIVED THAT THERE WAS NO IPG REPLACEMENT DONE. THE BATTERY WAS JUST MOVED TO ANOTHER LOCATION.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT WAS EXPERIENCING PAIN AT THE BATTERY SITE. THE PATIENT WILL UNDERGO A REVISION PROCEDURE WHEREIN THE IPG WILL BE REPLACED PER PREFERENCE AND WILL BE MOVED TO A COMFORTABLE LOCATION.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT WAS EXPERIENCING PAIN AT THE BATTERY SITE. THE PATIENT WILL UNDERGO A REVISION PROCEDURE WHEREIN THE IPG WILL BE REPLACED PER PREFERENCE AND WILL BE MOVED TO A COMFORTABLE LOCATION.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT WAS EXPERIENCING PAIN AT THE BATTERY SITE. THE PATIENT WILL UNDERGO A REVISION PROCEDURE WHEREIN THE IPG WILL BE REPLACED PER PREFERENCE AND WILL BE MOVED TO A COMFORTABLE LOCATION.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
450595 PRECISION® SPINAL CORD STIMULATOR LGW BOSTON SCIENTIFIC NEUROMODULATION SC-1110-02 NA

Patients

Seq Age Sex Outcome Treatment
1 59 YR Required Intervention