MAUDE Adverse Event Report: NALU MEDICAL INC. NALU NEUROSTIMULATION SYSTEM; SPINAL CORD STIMULATOR

Model Number 71004

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problem Post Operative Wound Infection (2446)

Event Date 11/28/2021

Event Type  Injury  

Event Description

Patient (b)(6) was implanted on (b)(6) 2021.Patient was activated on (b)(6) 2021.Patient went to urgent care on (b)(6) 2021, because incision was red.Patient was seen by implanting physician on (b)(6) 2021.Physician advised patient to continue to take antibiotics prescribed by urgent care.Patient was notified on (b)(6) 2021 that wound culture for infection came back positive.Patient will see wound care nurse 3 times week.

Event Description

Patient (b)(6) was implanted on (b)(6) 2021.Patient was activated on (b)(6) 2021.Patient went to urgent care on (b)(6) 2021, because incision was red.Patient was seen by implanting physician on (b)(6) 2021.Physician advised patient to continue to take antibiotics prescribed by urgent care.Patient was notified on (b)(6) 2021 that wound culture for infection came back positive.Patient will see wound care nurse 3 times week.

• Brand Name: NALU NEUROSTIMULATION SYSTEM
• Type of Device: SPINAL CORD STIMULATOR
• Manufacturer (Section D): NALU MEDICAL INC.; 2320 faraday avenue; suite #100; carlsbad CA 92008 7241
• Manufacturer (Section G): NALU MEDICAL INC.; 2320 faraday avenue; suite 100; carlsbad CA 92008 7241
• Manufacturer Contact: terry villarba ; 2320 faraday avenue; suite 100; carlsbad, CA 92008-7241 ; 7604482360
• MDR Report Key: 13080399
• MDR Text Key: 285193054
• Report Number: 3015425075-2021-00024
• Device Sequence Number: 1
• Product Code: GZB
• UDI-Device Identifier: 00812537033594
• UDI-Public: 01008125370335941121060817240608
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K183047
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date: 12/23/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 12/23/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: 71004
• Device Catalogue Number: 71004
• Device Lot Number: A00529
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 12/02/2021
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 06/08/2021
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Other
• Patient Sex: Male