| Brand Name | Quattrode Lead Wide Spaced, 60 cm |
| Common Device Name | SCS Lead |
| Manufacturer (Section D) |
| Abbott Medical |
| 6901 preston rd |
| plano TX 75024 |
|
| Manufacturer (Section G) |
| Abbott Medical |
| 6901 preston rd |
|
| plano TX 75024 |
|
| Manufacturer Contact |
|
sara
speyerer
|
| 6901 preston road |
| plano, TX 75024
|
|
+1(972)309-8000
|
|
| MDR Report Key | 50849947 |
| Report Number | 1627487-2026-10198 |
| Device Sequence Number | 15959082 |
| Product Code |
LGW
|
| UDI-Device Identifier | 05414734401661 |
| UDI-Public | (01)05414734401661(10)T00006353(17)260813 |
| Combination Product (Y/N) | N |
| Initial Reporter State | TX |
| Initial Reporter Country | US |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2025 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,Company Representative |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/21/2026 |
| 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 |
Health Professional
|
| Device Expiration Date | 08/13/2026 |
| Device Model Number | 3166 |
| Device Catalogue Number | 3166 |
| Device Lot Number | T00006353 |
| 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 | 08/24/2026 |
| Initial Report FDA Received Date | 09/22/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 08/13/2024 |
| 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 |
Concomitant Medical Products and Therapy/Usage Dates | SCS Extension (x2); SCS IPG; SCS Lead (x3) |
| Outcome Attributed to Adverse Event |
Other;
|
| Patient Sex | Female |
| Patient Weight | 150 LB |