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

Model Number	SC-3138-55
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	02/11/2026
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Block b3: approximated based on the date the manufacturer became aware of the event block d2b: additional applicable product codes: qrb.Additional suspect medical device components involved in the event: model number/catalog number: sc-3138-55.Serial number: (b)(6).Batch/lot number: (b)(6).Model/catalog description: lead extension kit, 55cm.Unique identifier (udi): (b)(4).Additional suspect medical device components involved in the event: model number/catalog number: sc-3138-55.Serial number: (b)(6).Batch/lot number: (b)(6).Model/catalog description: lead extension kit, 55cm.Unique identifier (udi): (b)(4).
Event or Problem Description
It was reported that the spinal cord stimulation (scs) patient underwent a revision procedure for an unspecified reason.The system was replaced.No additional information is available at this time.
Additional Manufacturer Narrative
The devices were not returned to boston scientific for analysis and the complaint as reported was not able to be confirmed.A review of the devices history record (dhr) confirmed that the devices met specification prior to shipping.No manufacturing deviations were noted that could have contributed to the event reported.Therefore, in the absence of device return and analysis the likely root cause could not be established.Block b3: approximated based on the date the manufacturer became aware of the event block d2b: additional applicable product codes: qrb.Additional suspect medical device components involved in the event: model number/catalog number: sc-3138-55.Serial number: (b)(6).Batch/lot number: (b)(6).Model/catalog description: lead extension kit, 55cm.Unique identifier (udi): (b)(4).Additional suspect medical device components involved in the event: model number/catalog number: sc-3138-55.Serial number: (b)(6).Batch/lot number: (b)(6).Model/catalog description: lead extension kit, 55cm.Unique identifier (udi): (b)(4).
Event or Problem Description
It was reported that the spinal cord stimulation (scs) patient underwent a revision procedure for an unspecified reason.The system was replaced.No additional information is available at this time.

• Brand Name: NA
• 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; * 00646-2602
• Manufacturer Contact: erik sherburne ; 25155 rye canyon loop; valencia, CA 91355 ; 7632920920
• MDR Report Key: 24582230
• Report Number: 3006630150-2026-01455
• Device Sequence Number: 9158078
• Product Code: LGW
• UDI-Device Identifier: 08714729760566
• UDI-Public: (01)08714729760566(17)200726(10)7028309
• Combination Product (Y/N): N
• Initial Reporter State: MD
• Initial Reporter Country: US
• PMA/510(K) Number: P030017
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2018
• Device Explanted Year: 2026
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 05/15/2026

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 Expiration Date: 07/26/2020
• Device Model Number: SC-3138-55
• Device Catalogue Number: SC-3138-55
• Device Lot Number: 7028309
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/11/2026
• Supplement Date Received by Manufacturer: 04/18/2026
• Initial Report FDA Received Date: 03/12/2026
• Supplement Report FDA Received Date: 05/15/2026
• Date Device Manufactured: 07/27/2018
• 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: 64 YR
• Patient Sex: Female