MAUDE Adverse Event Report: ABBOTT MEDICAL QUATTRODE LEAD WIDE SPACED, 60 CM; PERCUTANEOUS LEAD

Model Number 3166

Device Problem Fracture (1260)

Patient Problem Undesired Nerve Stimulation (1980)

Event Date 06/22/2021

Event Type  Injury  

Manufacturer Narrative

Date of event is estimated.The results of the investigation are inconclusive since the device was not returned for analysis.Based on the information received, the cause of the reported incident could not be conclusively determined.

Event Description

Related manufacturer reference number: 1627487-2021-16829.It was reported that the patient experienced ineffective and uncomfortable stimulation.Diagnostics revealed high impedances on all contacts of one lead.As a result, surgical intervention was undertaken wherein the lead was explanted and replaced.During the procedure, it was discovered that the lead had a fracture.Post-operatively, stimulation therapy was restored.It is unknown which lead had fractured and was replaced, therefore both leads are being reported.

• Brand Name: QUATTRODE LEAD WIDE SPACED, 60 CM
• Type of Device: PERCUTANEOUS LEAD
• Manufacturer (Section D): ABBOTT MEDICAL; 6901 preston rd; plano TX 75024
• Manufacturer (Section G): ABBOTT MEDICAL; 6901 preston rd; plano TX 75024
• Manufacturer Contact: ronnie shalev ; 6901 preston road; plano, TX 75024 ; 9723098000
• MDR Report Key: 12433756
• MDR Text Key: 270123236
• Report Number: 1627487-2021-16830
• Device Sequence Number: 1
• Product Code: LGW
• UDI-Device Identifier: 05414734406109
• UDI-Public: 05414734406109
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: P010032
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,consum
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 09/07/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 09/07/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 08/19/2022
• Device Model Number: 3166
• Device Catalogue Number: 3166
• Device Lot Number: 7629577
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 08/18/2021
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 08/19/2020
• 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
• Treatment: PERCUTANEOUS LEAD
• Patient Outcome(s): Other
• Patient Age: 32 YR
• Patient Weight: 50