BEUDAMED
    FDA Adverse Event Injury Summary report: N

    INFINION CX

    MDR report key: 9254012 · Received October 29, 2019

    Report

    Report Number
    3006630150-2019-06086
    Event Type
    Injury
    Date Received
    October 29, 2019
    Date of Event
    September 30, 2019
    Report Date
    October 29, 2019
    Manufacturer
    BOSTON SCIENTIFIC NEUROMODULATION
    Product Code
    LGW
    UDI-DI
    08714729861638
    PMA / PMN Number
    P030017
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NC, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    CONCOMITANT MEDICAL PRODUCTS: MODEL NUMBER/CATALOG NUMBER: SC-2317-70; SERIAL NUMBER: (B)(4); BATCH/LOT NUMBER: 5141344; MODEL/CATALOG DESCRIPTION: INFINION CX LEAD KIT, 70CM.

    Description of Event or Problem · 1

    A REPORT WAS RECEIVED THAT THE PATIENT UNDERWENT A LEAD REVISION PROCEDURE FOR AN UNKNOWN REASON.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1047848 INFINION CX STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF LGW BOSTON SCIENTIFIC NEUROMODULATION SC-2317-70 5118286 08714729861638

    Patients

    Seq Age Sex Outcome Treatment
    1 43 YR Required Intervention