MAUDE Adverse Event Report: BOSTON SCIENTIFIC NEUROMODULATION CORPORATION AVISTA? MRI; STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF

Model Number	SC-2408-56
Medical Device Problem Codes	Unexpected Therapeutic Results (1631); Migration (4003)
Health Effect - Clinical Code	Pain (1994)
Date of Event	12/15/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Block b3: exact date unknown, event occurred in mid-december 2025.Additional suspect medical device components involved in the event: product family: scs-linear leads-mri, upn: m365sc2408560, model: sc-2408-56, serial: (b)(6), batch: 7089231, udi: (b)(4).Product family: scs-ipg-pc, upn: m365sc14320, model: sc-1432, serial: (b)(6), batch: 240409, udi: (b)(4).Product family: scs-lead fixation-mri, upn: m365sc43190, model: sc-4319, batch: 34856782, udi: (b)(4).
Event or Problem Description
It was reported that the patient was experiencing inadequate pain relief.Imaging confirmed that the leads migrated.The patient underwent a spinal cord stimulator (scs) system replacement procedure and was doing well postoperatively.The explanted device components were discarded by the medical facility.
Event or Problem Description
It was reported that the patient was experiencing inadequate pain relief.Imaging confirmed that the leads migrated.The patient underwent a spinal cord stimulator (scs) system replacement procedure and was doing well postoperatively.The explanted device components were discarded by the medical facility.
Additional Manufacturer Narrative
Block b3: exact date unknown, event occurred in mid-december 2025.Investigation results the ipg and leads were not returned for analysis; therefore, a technical analysis could not be performed.The patient underwent a spinal cord stimulator (scs) system replacement procedure and was doing well postoperatively.The explanted device components were discarded by the medical facility.Device history record it was confirmed this device met manufacturing specification prior to distribution and there were no manufacturing deviations which could have contributed to the reported event.Labeling review review of the instructions for use (ifu) confirmed there was relevant content and sufficient guidance with respect to the circumstances described within this complaint.No updates are required to the ifu as a result of this event.Investigation conclusion based on a thorough review of the reported complaint, boston scientific has assigned an investigation conclusion code of known inherent risk of device.

• Brand Name: AVISTA? MRI
• Common Device Name: STIMULATOR, SPINAL-CORD, TOTALLY IMPLANTED FOR PAIN RELIEF
• Manufacturer (Section D): BOSTON SCIENTIFIC NEUROMODULATION CORPORATION; 25155 rye canyon loop; valencia CA 91355
• Manufacturer (Section G): BOSTON SCIENTIFIC CORPORATION; road 698, lot no. 12; dorado PR 00646 -260
• Manufacturer Contact: erik sherburne ; 25155 rye canyon loop; valencia, CA 91355 ; 7632920920
• MDR Report Key: 24379742
• Report Number: 3006630150-2026-00966
• Device Sequence Number: 10208652
• Product Code: LGW
• Combination Product (Y/N): N
• Initial Reporter State: NH
• Initial Reporter Country: US
• PMA/510(K) Number: P030017
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2025
• Device Explanted Year: 2026
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 05/06/2026

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?: No
• Operator of Device: Lay User/Patient
• Device Model Number: SC-2408-56
• Device Catalogue Number: SC-2408-56
• Device Lot Number: 7087866
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 01/28/2026
• Supplement Date Received by Manufacturer: 04/11/2026
• Initial Report FDA Received Date: 02/18/2026
• Supplement Report FDA Received Date: 05/06/2026
• Date Device Manufactured: 05/04/2025
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 41 YR
• Patient Sex: Female
• Patient Race: White