FDA Adverse Event
Injury
Summary report: N
INFINION CX
MDR report key: 9193226
·
Received October 15, 2019
Report
- Report Number
- 3006630150-2019-05765
- Event Type
- Injury
- Date Received
- October 15, 2019
- Date of Event
- September 26, 2019
- Report Date
- October 15, 2019
- Manufacturer
- BOSTON SCIENTIFIC NEUROMODULATION
- Product Code
- LGW
- UDI-DI
- 08714729861614
- PMA / PMN Number
- P030017
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- TX, US
- Reporter Occupation
- PHYSICIAN
Narratives
Additional Manufacturer Narrative · 1
MODEL NUMBER / CATALOG NUMBER: SC-2317-50, SERIAL NUMBER: (B)(4), BATCH / LOT NUMBER: 5102566, MODEL / CATALOG DESCRIPTION: INFINION CX LEAD KIT, 50 CM.
Description of Event or Problem · 1
A REPORT WAS RECEIVED THAT THE PATIENTS LEAD HAD MIGRATED. THE PATIENT UNDERWENT A REVISION PROCEDURE WHEREIN THE LEADS WERE REPOSITIONED. THE PATIENT WAS DOING WELL POSTOPERATIVELY.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 988896 | INFINION CX | STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF | LGW | BOSTON SCIENTIFIC NEUROMODULATION | SC-2317-50 | 5102401 | 08714729861614 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 51 YR | Required Intervention |