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 Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Bacterial Infection (1735)
Date of Event	09/23/2025
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that the patient developed an infection at the midline lead site and was administered with antibiotics.The patient underwent a spinal cord stimulator (scs) system explant procedure and there were no reported complications postoperatively.The explanted device components were discarded by the medical facility.
Additional Manufacturer Narrative
Block b3: exact date unknown, event occurred one to two weeks prior to the explant of the device.Additional suspect medical device components involved in the event: model number/catalog number: sc-2408-56, serial number: (b)(6), batch/lot number: 7085525, model/catalog description: avista mri perc lead kit 56 cm, unique identifier (udi) #: (b)(4).Model number/catalog number: sc-1216, serial number: (b)(6), batch/lot number: 779485, model/catalog description: wavewriter alpha 16 ipg kit, unique identifier (udi) #: (b)(4).Model number/catalog number: sc-4319, batch/lot number: 35612851, model/catalog description: clik x mri anchor, unique identifier (udi) #: (b)(4).
Additional Manufacturer Narrative
Block b3: exact date unknown, event occurred one to two weeks prior to the explant of the device.Investigation results the devices were not returned for analysis; therefore, a technical analysis could not be performed.The patient underwent a spinal cord stimulator (scs) system explant procedure and there were no reported complications 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.
Event or Problem Description
It was reported that the patient developed an infection at the midline lead site and was administered with antibiotics.The patient underwent a spinal cord stimulator (scs) system explant procedure and there were no reported complications postoperatively.The explanted device components were discarded by the medical facility.

• 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 2602
• Manufacturer Contact: erik sherburne ; 25155 rye canyon loop; valencia, CA 91355 ; 7632920920
• MDR Report Key: 24593117
• Report Number: 3006630150-2026-01475
• Device Sequence Number: 9466944
• Product Code: LGW
• UDI-Device Identifier: 08714729904816
• UDI-Public: (01)08714729904816(17)270204(10)7086666
• Combination Product (Y/N): N
• Initial Reporter State: OH
• 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: 2025
• 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): 05/13/2026

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: 7086666
• 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: 02/18/2026
• Supplement Date Received by Manufacturer: 04/19/2026
• Initial Report FDA Received Date: 03/13/2026
• Supplement Report FDA Received Date: 05/13/2026
• Date Device Manufactured: 02/04/2025
• 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: 79 YR
• Patient Sex: Male
• Patient Race: White