BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SPECTRA WAVEWRITER

    MDR report key: 8800999 · Received July 17, 2019

    Report

    Report Number
    3006630150-2019-03652
    Event Type
    Injury
    Date Received
    July 17, 2019
    Date of Event
    June 26, 2019
    Report Date
    July 17, 2019
    Manufacturer
    BOSTON SCIENTIFIC NEUROMODULATION
    Product Code
    LGW
    UDI-DI
    08714729951254
    PMA / PMN Number
    P030017
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    UT, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    MODEL NUMBER/CATALOG NUMBER: SC-8216-70, SERIAL NUMBER: (B)(4), BATCH/LOT NUMBER: 7032461, MODEL/CATALOG DESCRIPTION: ARTISAN LEAD 70 CM. THE EXPLANTED DEVICES WERE NOT RETURNED TO BSN AS THEY DISCARDED BY THE MEDICAL FACILITY. IT IS INDICATED THAT THE DEVICES WILL NOT BE RETURNED FOR EVALUATION; THEREFORE A FAILURE ANALYSIS OF THE COMPLAINT DEVICES COULD NOT BE COMPLETED. A REVIEW OF THE DEVICE HISTORY RECORDS WILL BE CONDUCTED. IF THERE IS ANY FURTHER RELEVANT INFORMATION FROM THAT REVIEW, A SUPPLEMENTAL MED WATCH WILL BE FILED.

    Description of Event or Problem · 1

    A REPORT WAS RECEIVED THAT THE PATIENT DEVELOPED AN INFECTION AT THE INCISION SITE. SYMPTOMS OF REDNESS, SWELLING AND FEVER WAS NOTED. IT WAS UNKNOWN WHAT CAUSED THE INFECTION. THE PATIENT WAS PRESCRIBE ANTIBIOTICS. THE PATIENT UNDERWENT AN SCS EXPLANT PROCEDURE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    592987 SPECTRA WAVEWRITER STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF LGW BOSTON SCIENTIFIC NEUROMODULATION SC-1160 334354 08714729951254

    Patients

    Seq Age Sex Outcome Treatment
    1 58 YR Required Intervention