| Brand Name | Linear? ST |
| 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 |
|
PR
00646-2602
|
|
| Manufacturer Contact |
|
ricardo
amaro castro
|
| 25155 rye canyon loop |
| valencia, CA 91355
|
|
+1(320)800-7570
|
|
| MDR Report Key | 50779699 |
| Report Number | 3006630150-2026-06760 |
| Device Sequence Number | 9826416 |
| Product Code |
LGW
|
| UDI-Device Identifier | 08714729767725 |
| UDI-Public | (01)08714729767725(17)251212(10)7139076 |
| Combination Product (Y/N) | N |
| Initial Reporter State | TN |
| Initial Reporter Country | US |
| PMA/510(K) Number | P030017 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2024 |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,Company Representative |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/15/2026 |
| 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? |
Yes
|
| Operator of Device |
Lay User/Patient
|
| Device Expiration Date | 12/12/2025 |
| Device Model Number | SC-2218-50 |
| Device Catalogue Number | SC-2218-50 |
| Device Lot Number | 7139076 |
| 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 | 08/21/2026 |
| Initial Report FDA Received Date | 09/15/2026 |
| Date Device Manufactured | 12/13/2023 |
| 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 | 55 YR |
| Patient Sex | Female |
| Patient Weight | 168 LB |