FDA Adverse Event Injury Summary report: N

PRECISION®

MDR report key: 4100248 · Received September 18, 2014

Report

Report Number
3006630150-2014-02134
Event Type
Injury
Date Received
September 18, 2014
Report Date
June 5, 2014
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

DATE RECEIVED BY MFR: SHOULD HAVE BEEN 03-SEP-2014.

Additional Manufacturer Narrative · 1

DATE OF EVENT: (B)(6) 2013.

Additional Manufacturer Narrative · 1

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

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT WAS EXPERIENCING DISCOMFORT, BURNING AND STINGING SENSATION WITH STIMULATION. THE IPG WAS PROTRUDING AND LYING IN A VERTICAL PLANE TO THE SKIN. THE PATIENT WILL UNDERGO A REVISION PROCEDURE WHEREIN THE IPG WILL BE REPOSITIONED.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT WAS EXPERIENCING DISCOMFORT, BURNING AND STINGING SENSATION WITH STIMULATION. THE IPG WAS PROTRUDING AND LYING IN A VERTICAL PLANE TO THE SKIN. THE PATIENT WILL UNDERGO A REVISION PROCEDURE WHEREIN THE IPG WILL BE REPOSITIONED.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT WAS EXPERIENCING DISCOMFORT, BURNING AND STINGING SENSATION WITH STIMULATION. THE IPG WAS PROTRUDING AND LYING IN A VERTICAL PLANE TO THE SKIN. THE PATIENT WILL UNDERGO A REVISION PROCEDURE WHEREIN THE IPG WILL BE REPOSITIONED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
580387 PRECISION® SPINAL CORD STIMULATOR LGW BOSTON SCIENTIFIC NEUROMODULATION SC-1110-02 NA

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention