FDA Adverse Event Injury Summary report: N

PRECISION®

MDR report key: 4122611 · Received September 26, 2014

Report

Report Number
3006630150-2014-02188
Event Type
Injury
Date Received
September 26, 2014
Date of Event
August 13, 2014
Report Date
September 4, 2014
Manufacturer
BOSTON SCIENTIFIC NEUROMODULATION
Product Code
LGW
PMA / PMN Number
030017
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
IL, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

ADDITIONAL INFORMATION WAS RECEIVED THAT THE PATIENT UNDERWENT A SURGICAL PROCEDURE WHEREIN THE IPG WAS REPLACED. NO DEVICE MALFUNCTION WAS SUSPECTED. THE PATIENT WAS REPORTEDLY DOING WELL POST OPERATIVELY. THE EXPLANTED DEVICES WERE NOT RETURNED TO BSN AS THEY WERE DISCARDED BY THE MEDICAL FACILITY.

Additional Manufacturer Narrative · 1

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

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT¿S IPG COULD NOT HOLD A CHARGE. THE STIMULATOR HAD NOT WORKED THE SAME SINCE A LIGHTNING STRUCK CLOSE TO THE PATIENT¿S HOUSE. THE PATIENT WILL UNDERGO A REVISION PROCEDURE.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT¿S IPG COULD NOT HOLD A CHARGE. THE STIMULATOR HAD NOT WORKED THE SAME SINCE A LIGHTNING STRUCK CLOSE TO THE PATIENT¿S HOUSE. THE PATIENT WILL UNDERGO A REVISION PROCEDURE.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT¿S IPG COULD NOT HOLD A CHARGE. THE STIMULATOR HAD NOT WORKED THE SAME SINCE A LIGHTNING STRUCK CLOSE TO THE PATIENT¿S HOUSE. THE PATIENT WILL UNDERGO A REVISION PROCEDURE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
600708 PRECISION® SPINAL CORD STIMULATOR LGW BOSTON SCIENTIFIC NEUROMODULATION SC-1110-02 NA

Patients

Seq Age Sex Outcome Treatment
1 57 YR Required Intervention