Brand Name | WAVEWRITER ALPHA 16 |
Type of Device | STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF |
Manufacturer (Section D) |
BOSTON SCIENTIFIC NEUROMODULATION |
25155 rye canyon loop |
valencia CA 91355 |
|
MDR Report Key | 12518123 |
MDR Text Key | 272861853 |
Report Number | 3006630150-2021-05326 |
Device Sequence Number | 1 |
Product Code |
LGW
|
UDI-Device Identifier | 08714729985082 |
UDI-Public | 08714729985082 |
Combination Product (y/n) | N |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,health |
Type of Report
| Initial,Followup |
Report Date |
10/18/2021 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 09/23/2021 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Lay User/Patient
|
Device Expiration Date | 02/03/2023 |
Device Model Number | SC-1216 |
Device Catalogue Number | SC-1216 |
Device Lot Number | 504561 |
Was Device Available for Evaluation? |
No
|
Date Manufacturer Received | 09/23/2021 |
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 70 YR |
|
|