FDA Adverse Event Injury Summary report: N

PRECISION SPECTRA®

MDR report key: 5707925 · Received June 8, 2016

Report

Report Number
3006630150-2016-01463
Event Type
Injury
Date Received
June 8, 2016
Date of Event
May 12, 2016
Report Date
May 12, 2016
Manufacturer
BOSTON SCIENTIFIC NEUROMODULATION
Product Code
LGW
PMA / PMN Number
030017
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
KY, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

(B)(4).

Additional Manufacturer Narrative · 1

ADDITIONAL INFORMATION WAS RECEIVED THAT EVERYTHING WAS EXPLANTED FROM THE PATIENT INCLUDING THE MISSING ELECTRODE AND 32 CONTACT LEAD. SC-8336-50/1071277 DEVICE EVALUATION INDICATED THAT THE PADDLE LEAD RIPPED INSIDE THE PATIENT'S BODY AS CONFIRMED BY REP'S SUBMITTED IMAGES. THE VISUAL INSPECTION OF THE PADDLE LEAD REVEALED THAT SILICON WAS TORN AND ONE SECTION IS MISSING. IN ADDITION, THE CABLES NEAR THE PADDLE WERE PULLED AND EXPOSED. X-RAY INSPECTION FOUND THAT 19 OUT OF 32 ELECTRODES ARE MISSING FROM THE PADDLE.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT EXPERIENCED LOSS OF STIMULATION. AN IMAGING WAS TAKEN AND SHOWED SIGNS OF THE LEAD POSSIBLY BENDING AND THE CONTACTS HAD FALLEN OF. IT WAS DETERMINED THAT THE LEAD WAS RIPPED INTO SEVERAL PIECES AND WAS NO LONGER WORKING. THE LEAD WAS REPLACED AND THE PATIENT WAS REPORTEDLY DOING WELL POSTOPERATIVELY.

Description of Event or Problem · 1

A REPORT WAS RECEIVED THAT THE PATIENT EXPERIENCED LOSS OF STIMULATION. AN IMAGING WAS TAKEN AND SHOWED SIGNS OF THE LEAD POSSIBLY BENDING AND THE CONTACTS HAD FALLEN OF. IT WAS DETERMINED THAT THE LEAD WAS RIPPED INTO SEVERAL PIECES AND WAS NO LONGER WORKING. THE LEAD WAS REPLACED AND THE PATIENT WAS REPORTEDLY DOING WELL POSTOPERATIVELY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
360647 PRECISION SPECTRA® SPINAL CORD STIMULATOR LGW BOSTON SCIENTIFIC NEUROMODULATION SC-8336-50 NA

Patients

Seq Age Sex Outcome Treatment
1 62 YR Required Intervention