Brand Name | PRECISION MONTAGE MRI |
Type of Device | STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF |
Manufacturer (Section D) |
BOSTON SCIENTIFIC NEUROMODULATION |
25155 rye canyon loop |
valencia CA 91355 |
|
Manufacturer (Section G) |
BOSTON SCIENTIFIC CORPORATION |
25155 rye canyon loop |
|
valencia CA 91355 |
|
Manufacturer Contact |
erik
sherburne
|
25155 rye canyon loop |
valencia, CA 91355
|
7632920920
|
|
MDR Report Key | 15609006 |
MDR Text Key | 301772413 |
Report Number | 3006630150-2022-05544 |
Device Sequence Number | 1 |
Product Code |
LGW
|
UDI-Device Identifier | 08714729905943 |
UDI-Public | 08714729905943 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P030017 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,Company Representative |
Reporter Occupation |
Physician
|
Type of Report
| Initial,Followup |
Report Date |
09/14/2023 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Lay User/Patient
|
Device Expiration Date | 10/17/2019 |
Device Model Number | SC-1200 |
Device Catalogue Number | SC-1200 |
Device Lot Number | 21264936 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
09/26/2022 |
Initial Date FDA Received | 10/14/2022 |
Supplement Dates Manufacturer Received | 08/25/2023
|
Supplement Dates FDA Received | 09/14/2023
|
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 10/17/2017 |
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) |
Required Intervention;
|
Patient Age | 60 YR |
Patient Sex | Female |
Patient Weight | 70 KG |
|
|