MAUDE Adverse Event Report: NEVRO CORP. SENZA; NEVRO SENZA

Model Number	LEAD3005-50B
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Unspecified Infection (1930)
Date of Event	09/04/2018
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
The device was explanted but not returned.The manufacturing records were reviewed and no non-conformities related to the nature of the complaint were found.
Event or Problem Description
It was reported to nevro that the patient acquired a slight infection during the trial.As a consequence, the patient went to the er and was given oral antibiotics.The following day, the patient proceeded with the permanent implant since the trial was successful.During the implant procedure, purulent drainage was found.As a result, the device was explanted.Nevro attempted to obtain additional information regarding the nature of the infection but was unsuccessful.There have been no reports of further complications regarding this event.

• Brand Name: SENZA
• Common Device Name: NEVRO SENZA
• Manufacturer (Section D): NEVRO CORP.; 1800 bridge parkway; redwood city CA 94065
• MDR Report Key: 7928408
• Report Number: 3008514029-2018-00418
• Device Sequence Number: 2052493
• Product Code: LGW
• UDI-Device Identifier: 00813426020398
• UDI-Public: 00813426020398
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: P130022
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2018
• Device Explanted Year: 2018
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 10/02/2018

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: 04/24/2021
• Device Model Number: LEAD3005-50B
• Device Lot Number: 94424771
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/04/2018
• Initial Report FDA Received Date: 10/02/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other
• Patient Age: 57 YR