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dennis100
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« Reply #90 on: January 11, 2019, 01:38:17 AM »

Model Number 302-20
Event Date 03/26/2014
Event Type  Malfunction   
Manufacturer Narrative
Review of the available programming and diagnostic history. Describe event or problem, corrected data: the initial manufacturer report inadvertently did not include the review of the available programming and diagnostic history. Relevant tests/laboratory data, including dates, corrected data: the initial manufacturer report inadvertently did not include the review of the available programming and diagnostic history. Evaluation codes, including dates, corrected data: the initial manufacturer report inadvertently did not include the review of the available programming and diagnostic history.
 
Event Description
Review of the available programming and diagnostic history showed normal diagnostic results through (b)(6) 2011.
 
Event Description
It was reported that during generator replacement for end of service, high impedance (9225 ohms) was seen when the new generator was attached to the existing lead. It was reported that interrogation of the device prior to surgery was unsuccessful and the high impedance was not observed until the new generator was attached. The surgeon went to explant the lead and observed that the tubing was "stripped back and exposed down to the wire". The surgeon was unclear if any trauma caused the damage. It was reported that the patient was recently mugged which resulted in bruising; however, it is unknown if this may have caused or contributed to the high impedance. The lead was explanted (leaving electrodes) and a new lead was placed. Diagnostics with the new generator attached to the new lead were within normal limits (1556 ohms). The generator and lead were returned for analysis. Analysis of the lead was completed on (b)(4) 2014. Note that the (+) white and (-) green electrodes were not returned for analysis; therefore a complete evaluation could not be performed on the entire lead product. During the visual analysis abraded openings were observed on the outer silicone tubing. During the visual analysis of the returned 292mm portion the (-) connector pin quadfilar coil appeared to be broken approximately 282mm from the end of the connector boot. Scanning electron microscopy was performed and identified the area on two of the broken coil strands as being mechanically damaged which prevented identification of the coil fracture type, no pitting and residual material. The two remaining broken coil strands were identified as having evidence of a stress induced fracture (fatigue appearance) with mechanical damage and no pitting. One of the broken coil strands was identified as having evidence of a stress induced fracture (torsional appearance) which most likely completed the fracture. During the visual analysis of the returned 146mm portion the end of the (-) green electrode quadfilar coil appeared to be broken approximately 31mm from the end of the abraded open / cut outer silicone tubing. Scanning electron microscopy was performed and identified the area as being mechanically damaged which prevented identification of the coil fracture type and no pitting. Determination could not conclusively be made on the fracture mechanism. It is unknown if the breaks occurred while stimulation was present due to the absence of metal pitting on the broken coil wire surfaces. For the observed inner tubing fluid remnants, there was no obvious path for fluid ingress other than the cut ends that were made during the explanted process. The abraded openings found on the outer silicone tubing, most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids inside the outer silicone tubing. What appeared to be white deposits were observed in various locations. Eds (energy dispersion spectroscopy ¿ provides chemical or element identity/composition analysis) was performed and identified the deposit as containing silicon, phosphorus, sodium, magnesium, potassium, aluminum, sulphur and calcium. With the exception of the observed discontinuities and abraded openings, the condition of the returned lead portions is consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted. The setscrew marks found on the lead connector pin provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portions were performed, during the visual analysis, and no other discontinuities were identified. Analysis of the generator was completed on (b)(4) 2014. The pulse generator module performed according to functional specifications. There was no condition noted during the product analysis evaluation that would suggest any anomaly with the device.
 
Manufacturer Narrative
Failure occurred, but did not cause or contribute to a death or serious injury.

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dennis100
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« Reply #91 on: January 12, 2019, 01:47:23 AM »

Model Number 302-30
Event Date 03/17/2014
Event Type  Malfunction   
Manufacturer Narrative
Device failure occurred, but did not cause or contribute to a death or serious injury.
 
Event Description
Analysis of the lead was completed on 04/22/2014. During the visual analysis the (+) white electrode quadfilar coil appeared to be broken approximately 1. 5mm from the proximal end of the anchor tether. Scanning electron microscopy was performed identified the area as being mechanically damaged with pitting. Pitting was observed on the coil surface. It is believed that stimulation was present for a certain period of time as evidenced by the presence of metal pitting. Low magnification sem analysis of the quadfilar coil shows characteristics typical of a lead discontinuity which may include: material fracture, rough or pitted surface, thinned material thickness, electro-etching or material dissolution. The abraded opening found on the outer silicone tubing, most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids inside the outer silicone tubing. What appeared to be white deposits were observed in various locations. Eds (energy dispersion spectroscopy, provides chemical or element identity/composition analysis) was performed and identified the deposit as containing silicon, phosphorus, sodium, magnesium, aluminum, sulphur and calcium. Refer to attached eds sheet for additional information. With the exception of the observed discontinuity, the condition of the returned lead portions is consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted. The setscrew marks found on the lead connector pin provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portions were performed, during the visual analysis, and no other discontinuities were identified.
 
Manufacturer Narrative
Device manufacturing records were reviewed. Review of manufacturing records of the lead confirmed all quality tests were passed prior to distribution. Device failure is suspected, but did not cause or contribute to a death or serious injury.
 
Event Description
It was reported that device diagnostics resulted in high impedance and the patient was referred for surgery. The patient underwent generator and lead replacement on (b)(6) 2014. Pre-operative device diagnostics resulted in high impedance. The explanted generator and lead were returned for analysis on (b)(6) 2014. Analysis of the generator was completed on (b)(6) 2014. The device performed according to functional specifications. Analysis of the generator in the pa lab concluded that no abnormal performance or any other type of adverse condition was found; however, during decontamination an elective replacement indicator was observed. Analysis of the lead is underway, but has not been completed to date. Further follow-up revealed that no patient manipulation or trauma occurred that is believed to have caused or contributed to the high impedance. Attempts to obtain additional information have been unsuccessful to date.

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dennis100
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« Reply #92 on: January 23, 2019, 01:20:13 AM »

Model Number 300-20
Event Date 06/02/2014
Event Type  Malfunction   
Event Description
Additional information was received that the generator and lead were returned to the manufacturer for evaluation. Product analysis was completed on the generator but has not been completed on the lead. In the pa lab, the device output signal was monitored for more than 24-hrs, while the generator was placed in a simulated body temperature environment. Results showed no signs of variation in the pulse generator¿s output signal and demonstrated that the device provided the expected level of output current for the entire monitoring period. The pulse generator diagnostics were as expected for the programmed parameters. In addition, a comprehensive automated electrical evaluation showed that the pulse generator performed according to functional specifications. The battery, 2. 945 volts, shows a non-ifi condition. The data in the diagaccumconsumed memory locations revealed that 14. 910% of the battery had been consumed. There were no performance or any other type of adverse conditions found with the pulse generator.
 
Manufacturer Narrative
Device failure is suspected, but did not cause or contribute to a death or serious injury.
 
Manufacturer Narrative
Device failure is suspected, but did not cause or contribute to a death or serious injury.
 
Event Description
Additional information was received that product analysis was completed on the lead. Note that a portion of the lead assembly including the electrodes was not returned for analysis and therefore a complete evaluation could not be performed on the entire lead product. The abraded opening found on the outer silicone tubing and the cut ends that were made during the explanted process, most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids found inside the outer silicone tubing. The slice mark found on the (-) unmarked connector inner silicone tubing and the cut ends that were made during the explanted process, most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids found inside the inner silicone tubing. What appeared to be white deposits were observed in various locations. Eds (energy dispersion spectroscopy - provides chemical or element identity/composition analysis) was performed and identified the deposit as containing silicon, phosphorus, sodium, magnesium, potassium, sulphur, chlorine and calcium. Refer to eds sheet for additional information. The condition of the returned lead portions is consistent with conditions that typically exist following an explant procedure. No obvious anomalies were noted. The setscrew marks found on the lead connector pins provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portions were performed, during the visual analysis, and no discontinuities were identified. Based on the findings in the product analysis lab, there is no evidence to suggest discontinuities in the returned portion of the device which may have contributed to high impedance. Note that since a portion of the lead assembly including the electrode array section was not returned for analysis, an evaluation and resulting commentary cannot be made on that portion of the lead.
 
Event Description
It was reported that device diagnostics resulted in high impedance (> 10,000 ohms). It was reported that the patient was reporting an increase in seizures. It was noted that the patient suffers from drop attacks which are believed to be due to the high impedance. It was reported that the drop attacks are normally controlled with vns. There was no recent trauma and the patient did not manipulate the device through the skin. The patient underwent generator and lead replacement. The explanted devices are expected to be returned for analysis, but have not been received to date.

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dennis100
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« Reply #93 on: January 23, 2019, 01:21:03 AM »

Model Number 302-20
Event Date 06/02/2014
Event Type  Malfunction   
Event Description
It was reported that device diagnostics resulted in high impedance. It was reported that x-rays were taken and did not identify any lead discontinuity; however, a portion of the lead was not visible. The patient was seen again and subsequent device diagnostics resulted in high impedance (dc dc code - 7). The device was programmed off and the patient was referred for surgery. No surgical intervention has been performed to date.
 
Manufacturer Narrative
Device failure occurred, but did not cause or contribute to a death or serious injury.
 
Event Description
The explanted lead and generator were received for analysis. Analysis of the generator was completed on 01/07/2015. Analysis of the generator in the pa lab concluded that no abnormal performance or any other type of adverse condition was found. Analysis of the lead was completed on 01/09/2015. During the visual analysis the (+) connector ring quadfilar coil appeared to be broken approximately 233mm and 241mm from the end of the connector boot. Scanning electron microscopy was performed on the (+) connector ring quadfilar coil break (found at 233mm) and identified the area as having extensive pitting which prevented identification of the coil fracture type. Pitting was observed on the coil surface. Scanning electron microscopy was performed on the (+) connector ring quadfilar coil break (found at 241mm) and identified the area on three of the broken coil strands as being mechanically damaged which prevented identification of the coil fracture type with pitting on two of the broken coil strands. The remaining broken coil strand was identified as having evidence of a stress induced fracture (fatigue appearance) with mechanical damage, no pitting and evidence of a stress induced fracture (torsional appearance) which most likely completed the fracture. It is believed that stimulation was present for a certain period of time as evidenced by the presence of metal pitting. Low magnification sem analysis of the quadfilar coil shows characteristics typical of a lead discontinuity which may include: material fracture, rough or pitted surface, thinned material thickness, electro-etching or material dissolution. The abraded openings found on the outer and 1 inner silicone tubing most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids found inside the outer and inner silicone tubing. What appeared to be white deposits were observed on the outer silicone tubing. Eds (energy dispersion spectroscopy provides chemical or element identity/composition analysis) was performed and identified the deposit as containing silicon, phosphorus, sodium, zirconium, magnesium, sulphur and calcium. With the exception of the observed discontinuities the condition of the returned lead portion is consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted. The setscrew marks found on the lead connector pin provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portion were performed, during the visual analysis, and no other discontinuities were identified.
 
Manufacturer Narrative
Device failure occurred, but did not cause or contribute to a death or serious injury.
 
Event Description
Follow-up revealed that the vns patient underwent generator and lead replacement surgery on (b)(6) 2014 due to high impedance. The explanted devices have not been returned to date.
 
Event Description
Additional information was received stating that the vns patient¿s device was tested and system diagnostic results revealed high impedance (dc dc ¿ 7).

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dennis100
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« Reply #94 on: January 27, 2019, 05:01:40 AM »

Model Number 300-20
Event Date 03/14/2014
Event Type  Malfunction   
Manufacturer Narrative
(b)(4).
 
Event Description
The explanted generator and lead were returned to the manufacturer for analysis. There were no performance or any other type of adverse conditions found with the pulse generator. Review of the as-received internal device data showed that the last 25% change in the impedance value was on (b)(6) 2014. Analysis of the returned lead is currently underway.
 
Manufacturer Narrative
Date of event; corrected data: additional information indicates that high impedance event occurred at least on (b)(6) 2014.
 
Event Description
It was reported that pre-operative diagnostics for generator replacement surgery resulted in high impedance. It was reported that the patient's device was interrogated for the first time in several years. It was reported that both the generator and lead were replaced. The patient was in a motor vehicle accident in 2012; however, it was unknown if this contributed to the high impedance. An implant card was received indicating that the generator and lead were replaced due to lead discontinuity (>10,000 ohms) and near end of service. It was reported that the explanted devices were discarded by the explanting facility; therefore, no analysis can be performed.
 
Event Description
Analysis of the lead was completed on 10/09/2014. Note that the electrodes were not returned for analysis; therefore a complete evaluation could not be performed on the entire lead product. During the visual analysis of the returned 88mm portion the (+) marked connector quadfilar coil appeared to be broken approximately 13mm past the end of the torn connector silicone / inner silicone tubes. Scanning electron microscopy was performed and identified the area on three of the broken coil strands as having evidence of a stress induced fracture (fatigue appearance) with mechanical damage, pitting on two of the broken coil strands, no pitting on one of the broken coil strands and evidence of a stress induced fracture (torsional appearance) which most likely completed the fracture was observed on one of the broken coil strands. The area on the fourth broken coil strand was identified as being mechanically damaged which prevented identification of the coil fracture type and no pitting. Pitting was observed on the coil surface. During the visual analysis of the returned 170mm portion the (-) unmarked connector quadfilar coil appeared to be broken approximately 2mm and 4mm from the end of the connector bifurcation. Scanning electron microscopy was performed on the (-) unmarked connector quadfilar coil break (found at 2mm) and identified the area on three of the broken coil strands as having evidence of a stress induced fracture (fatigue appearance) with mechanical damage, no pitting and evidence of a stress induced fracture (torsional appearance) which most likely completed the fracture on two of the broken coil strands. Scanning electron microscopy was performed on the (-) unmarked connector quadfilar coil break (found at 4mm) and identified the area three of the broken coil strands as having evidence of a stress induced fracture (fatigue appearance) with mechanical damage, no pitting and evidence of a stress induced fracture (torsional appearance) which most likely completed the fracture on one of the broken coil strands. The area on the fourth broken coil strand was identified as being mechanically damaged which prevented identification of the coil fracture type and no pitting. Pitting was observed on the coil surface. During the visual analysis of the returned 170mm portion the (+) marked connector quadfilar coil appeared to be broken approximately 4mm from the end of the connector bifurcation. Scanning electron microscopy was performed and identified the area as having evidence of a stress induced fracture (fatigue appearance) with mechanical damage, no pitting and evidence of a stress induced fracture (torsional appearance) which most likely completed the fracture on three of the broken coil strands. It is believed that stimulation was present for a certain period of time as evidenced by the presence of metal pitting. Low magnification sem analysis of the quadfilar coil shows characteristics typical of a lead discontinuity which may include: material fracture, rough or pitted surface, thinned material thickness, electro-etching or material dissolution. The abraded openings and slice marks found on the outer silicone tubing and the cut ends that were made during the explanted process, most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids found inside the outer silicone tubing. The slice mark found on one of the inner silicone tubes and the cut ends that were made during the explanted process, most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids found inside the inner silicone tubes. What appeared to be white deposits were observed in various locations. Eds (energy dispersion spectroscopy - provides chemical or element identity/composition analysis) was performed and identified the deposit as containing silicon, phosphorus, sodium, magnesium, potassium, aluminum, sulphur, chlorine and calcium. With the exception of the observed discontinuities the condition of the returned lead portions is consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted. The setscrew marks found on the lead connector pins provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portions were performed, during the visual analysis, and no other discontinuities were identified.
 
Manufacturer Narrative
Device failure is suspected, but did not cause or contribute to a death or serious injury.

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dennis100
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« Reply #95 on: January 28, 2019, 05:02:15 AM »

Model Number 302-30
Event Date 08/14/2014
Event Type  Malfunction   
Event Description
It was reported that the patient underwent generator and lead replacement. The generator and lead were received for analysis. Generator analysis was completed on 12/08/2014. A comprehensive automated electrical evaluation showed that the pulse generator performed according to functional specifications. There were no performance or any other type of adverse conditions found with the pulse generator. Analysis of the lead is underway, but has not been completed to date.
 
Event Description
Analysis of the lead was completed on 12/11/2014. Note that the electrodes were not returned for analysis; therefore a complete evaluation could not be performed on the entire lead product. During the visual analysis the (-) connector pin quadfilar coil appeared to be broken approximately 2. 5mm from the electrode bifurcation (and the coil appeared to be kinked). The (+) connector ring quadfilar coil appeared to be broken approximately 3mm from the electrode bifurcation. Scanning electron microscopy was performed on the (-) connector pin quadfilar coil break (found at 2. 5mm) and identified as having evidence of a stress induced fracture (fatigue appearance) with mechanical damage and pitting. Pitting was observed on the coil surface. Scanning electron microscopy was performed on the connector end of the (+) connector ring quadfilar coil break (found at 3mm) and identified the area as having evidence of a stress induced fracture (fatigue appearance) with mechanical damage and fine pitting. It is believed that stimulation was present for a certain period of time as evidenced by the presence of metal pitting. Low magnification sem analysis of the quadfilar coil shows characteristics typical of a lead discontinuity which may include: material fracture, rough or pitted surface, thinned material thickness, electro-etching or material dissolution. The abraded opening found on the outer silicone tubing, most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids inside the outer silicone tubing. What appeared to be white deposits were observed on the outer silicone tubing. Eds (energy dispersion spectroscopy ¿ provides chemical or element identity/composition analysis) was performed and identified the deposit as containing silicon, phosphorus, sodium, magnesium, aluminum, sulphur and calcium. With the exception of the observed discontinuities the condition of the returned lead portion is consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted. The setscrew marks found on the lead connector pin provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portion were performed, during the visual analysis, and no other discontinuities were identified.
 
Manufacturer Narrative
Device failure occurred, but did not cause or contribute to a death or serious injury.
 
Manufacturer Narrative
Device failure is suspected, but did not cause or contribute to a death or serious injury.
 
Event Description
Clinic notes dated (b)(6) 2014 note that interrogation of the device showed high impedance and was verified with a second interrogation. The patient was referred for surgery. No known surgical intervention has been performed to date. No additional relevant information has been received to date.

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« Reply #96 on: February 01, 2019, 11:20:11 AM »

Model Number 300-20
Event Date 09/01/2014
Event Type  Malfunction   
Manufacturer Narrative
Device failure occurred, but did not cause or contribute to a death or serious injury.
 
Event Description
It was initially reported that the patient had high impedance at a recent appointment. The patient¿s generator was turned off and the patient was referred for surgery. The patient had a generator and lead replacement and the explanted products were returned to the manufacturer for evaluation. A comprehensive automated electrical evaluation showed that the pulse generator performed according to functional specifications. The battery, 2. 986 volts as measured shows an ifi=no condition. The data in the diagaccumconsumed memory locations revealed that 2. 444% of the battery had been consumed. There were no performance or any other type of adverse conditions found with the pulse generator. Note that a large portion of the lead assembly (body) including the (+) white electrode was not returned for analysis and therefore a complete evaluation could not be performed on the entire lead product. During the visual analysis of the returned 91mm portion the (+) marked connector quadfilar coil appeared to be broken approximately 238mm past the end of the cut / torn / connector silicone / inner silicone tubes. Scanning electron microscopy was performed and identified the area as being mechanically damaged which prevented identification of the coil fracture type with fine pitting. Pitting was observed on the coil surface. It is believed that stimulation was present for a certain period of time as evidenced by the presence of metal pitting. Low magnification sem analysis of the quadfilar coil shows characteristics typical of a lead discontinuity which may include: material fracture, rough or pitted surface, thinned material thickness, electro-etching or material dissolution. The abraded openings found on the outer silicone tubing and the cut ends that were made during the explanted process, most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids found inside the outer silicone tubing. For the observed inner tubing fluid remnants, there was no obvious path for fluid ingress other than the cut ends that were made during the explanted process. What appeared to be white deposits were observed in various locations. Eds (energy dispersion spectroscopy ¿ provides chemical or element identity/composition analysis) was performed and identified the deposit as containing silicon, phosphorus, sodium, magnesium, aluminum and calcium. With the exception of the observed discontinuity the condition of the returned lead portions is consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted. The setscrew marks found on the lead connector pins provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portions were performed, during the visual analysis, and no other discontinuities were identified. Based on the findings in the product analysis lab, there is evidence to suggest discontinuities in the returned portions of the device which may have contributed to the stated allegations of high impedance. Note that since a large portion of the lead assembly (body) including the (+) white electrode was not returned for analysis, an evaluation and resulting commentary cannot be made on that portion of the lead.

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« Reply #97 on: February 04, 2019, 01:11:20 AM »

Model Number 302-20
Event Date 10/21/2014
Event Type  Malfunction   
Manufacturer Narrative
Device failure occurred, but did not cause or contribute to a death.
 
Manufacturer Narrative
Device failure is suspected, but did not cause or contribute to a death or serious injury.
 
Event Description
On (b)(4) 2014, product analysis was completed on the generator. An open can measurement of the battery voltage confirmed that the eri flag had been properly set; the battery was partially depleted. The partially depleted battery condition was the result of normal, expected battery depletion based on the battery life calculation, the electrical test results and the bench evaluation. Analysis of the generator in the pa lab concluded that no abnormal performance or any other type of adverse condition was found. Product analysis on the lead was completed on 12/3/2014 which confirmed discontinuity of quadfilar coil (unknown polarity) in the electrode region of the returned lead portions; also observed abraded openings of both outer and inner tubing in body region of lead. A portion of the lead assembly including the electrodes was not returned for analysis; therefore a complete evaluation could not be performed on the entire lead product. During the visual analysis of the returned 41mm portion quadfilar coil 1 appeared to be broken approximately 18mm from the end of the electrode bifurcation. Scanning electron microscopy was performed on the connector end of the quadfilar coil 1 coil break (found at 18mm) and identified the area on three of the broken coil strands as being mechanically damaged which prevented identification of the coil fracture type and no pitting. The remaining broken coil strand was identified as being mechanically damaged which prevented identification of the coil fracture type with pitting and evidence of a stress induced fracture (torsional appearance) which most likely completed the fracture. Scanning electron microscopy was performed on the electrode (mating) end of the quadfilar coil 1 coil break (found at 18mm) and identified the area on two of the broken coil strands as being mechanically damaged which prevented identification of the coil fracture type with pitting. The remaining broken coil strands were identified as having extensive pitting which prevented identification of the coil fracture type with mechanical damage. It is believed that stimulation was present for a certain period of time as evidenced by the presence of metal pitting. Low magnification sem analysis of the quadfilar coil shows characteristics typical of a lead discontinuity which may include: material fracture, rough or pitted surface, thinned material thickness, electro-etching or material dissolution. The abraded open / cut and slice marks observed on the outer and inner silicone tubes and the cut ends that were made during the explanted process, most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids found inside the outer and inner silicone tubing. What appeared to be white deposits were observed in various locations. Eds (energy dispersion spectroscopy -provides chemical or element identity/composition analysis) was performed and identified the deposit as containing phosphorus, sodium, magnesium, aluminum, sulphur and calcium. Refer to attached eds sheet for additional information. With the exception of the observed discontinuity the condition of the returned lead portions is consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted. The setscrew marks found on the lead connector pin provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portions were performed, during the visual analysis, and no other discontinuities were identified.
 
Event Description
Clinic notes dated (b)(6) 2014 reported that the patient's device was unable to be interrogated due to "not-functioning. " the physician¿s office attributed the failure to interrogate to normal end of service which was substantiated by battery life calculation results of 0 years remaining until neos condition at that time in (b)(6) 2014. The notes also reported that the patient¿s seizures were ¿recurring. ¿ it was noted that sometimes the patient does not take her anti-seizure medication regularly. The patient was seen for surgical consult for generator replacement on (b)(6) 2014, and the surgeon was able to perform diagnostics at which time high lead impedance was discovered. The patient had surgery on (b)(6) 2014. Pre-operatively, system diagnostic test was performed and results were high lead impedance. After the generator was replaced, high lead impedance still was observed. Therefore, the lead was also replaced. After the lead was replaced, diagnostics were within normal limits. The explanted devices were returned to the manufacturer for analysis, but analysis has not completed to date.

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« Reply #98 on: February 06, 2019, 01:19:38 AM »

Model Number 104
Event Date 11/11/2014
Event Type  Death   
Event Description
Analysis of the lead was completed on 12/15/2014. Note that the lead assembly (body) including the electrodes was not returned for analysis; therefore a complete evaluation could not be performed on the entire lead product. What appeared to be white deposits were observed in various locations. Eds (energy dispersion spectroscopy ¿ provides chemical or element identity/composition analysis) was performed and identified the deposit as containing silicon, phosphorus, sodium, sulphur and calcium. The condition of the returned lead portions is consistent with conditions that typically exist following an explant procedure. No obvious anomalies were noted. The setscrew marks found on the lead connector pins provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portions were performed, during the visual analysis, and no discontinuities were identified. Analysis of the generator was completed on 12/16/2014. A comprehensive automated electrical evaluation showed that the pulse generator performed according to functional specifications. There were no performance or any other type of adverse conditions found with the pulse generator.
 
Event Description
It was reported that the vns patient passed away. The funeral home indicated that the patient passed away at home and no autopsy would be performed. The cause of death was noted to be intracerebral hemorrhage. The device was explanted and received for analysis. Analysis is underway, but has not been completed to date.

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« Reply #99 on: February 13, 2019, 01:13:16 AM »

Model Number 302-20
Event Date 01/23/2015
Event Type  Malfunction   
Event Description
The explanted lead was returned for analysis on (b)(4) 2015. Product analysis for the lead was completed and approved on (b)(4) 2015. An analysis was performed on the returned lead portions and a condition was observed that could potentially contribute to the reported ¿low impedance / low impedance message, short circuit condition¿ (lead section) allegations. The bare and exposed conductive coils may be a contributing factor. Note that since a portion of the lead assembly including the electrodes was not returned for analysis, an evaluation and resulting commentary cannot be made on that portion of the lead. Abraded openings were observed on the outer silicone tubing and both of the inner silicone tubes. The quadfilar coils appeared to be stretched, kinked and bare, in some areas. The abraded openings found on the outer silicone tubing and the cut ends that were made during the explanted process, most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids found inside the outer silicone tubing. What appeared to be white deposits were observed in various locations. With the exception of the abraded openings, the condition of the returned lead portions is consistent with those that typically exist following an explant procedure. No other obvious anomalies were noted. The setscrew marks found on the lead connector pin provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portions were performed, during the visual analysis, and no discontinuities were identified.
 
Event Description
It was reported that device diagnostics resulted in low impedance (<600 ohms) and that the patient has experienced worsening seizures. The patient was referred for lead replacement. The patient underwent lead replacement on (b)(6) 2015. It was reported that device diagnostics with the new lead and existing generator were within normal limits. The explanted lead has not been received for analysis to date. No additional relevant information has been received to date.
 
Manufacturer Narrative
Device manufacturing records were reviewed. Review of manufacturing records of the lead confirmed all quality tests were passed prior to distribution. Device failure is suspected, but did not cause or contribute to a death or serious injury.
 
Manufacturer Narrative
Device failure occurred, but did not cause or contribute to death or serious injury.

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« Reply #100 on: February 15, 2019, 02:57:59 AM »

Model Number 302-20
Event Date 02/12/2013
Event Type  Malfunction   
Manufacturer Narrative
Device failure occurred, but did not cause or contribute to a death or serious injury.
 
Event Description
Clinic notes received (b)(4) 2015 and dated (b)(6) 2015 state that the patient is being seen for vns surgery, possible battery replacement. Notes state that the device worked well for several years then ¿stopped. ¿ battery interrogated and battery is dead. The patient was seen to discuss replacing the vns generator and electrodes. The patient underwent a full replacement on (b)(6) 2015. The generator and lead were received on (b)(4) 2015. Analysis is underway but has not been completed to date.
 
Event Description
Clinic notes dated (b)(6) 2015 were received. The notes state that the patient reports breakthrough spells and seizures.
 
Manufacturer Narrative

Manufacturer Narrative
Device failure occurred, but did not cause or contribute to death or serious injury.
 
Event Description
Product analysis for the generator was completed and approved on 06/16/2015. The end of service condition was the result of normal, expected battery depletion based on the battery life calculation, the electrical test results and the bench evaluation. The device performed according to functional specifications. Analysis of the generator in the product analysis lab concluded that no abnormal performance or any other type of adverse condition was found. Product analysis for the lead was completed and approved on 06/25/2015. The lead assembly was returned for analysis and a break was identified in the positive coil. Scanning electron microscopy images of the positive coil ends and strand segments found in the organic matter show that pitting or electro-etching conditions have occurred at the break locations. Also, images of the suspected positive coil mating end and some of the strand segments show what appears to be wear (flat surfaces) on the coil strands. An abrasion was noted on the connector boot. White deposits were noted at the end of the connector boot. Abrasions were noted on the outer silicone tubing at multiple locations. The outer silicone tubing has a compressed appearance at multiple locations. A portion of the lead assembly is covered with what appears to be organic matter. The inner silicone tubing of the negative coil is abraded. Other than the above mentioned observations and typical wear and explant related observations, no other anomalies were identified in the returned lead portion.
 
Event Description
On (b)(6) 2015 programming history was reviewed, and high impedance was observed. On (b)(6) 2004 (adjusted date (b)(6) 2013) the device was interrogated and a system diagnostic was performed and resulted in high lead impedance. No further programming history is available.

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« Reply #101 on: February 20, 2019, 11:17:23 AM »

Model Number 302-20
Event Date 03/12/2015
Event Type  Malfunction   
Manufacturer Narrative
Device manufacturing records were reviewed. Review of manufacturing records confirmed that the lead passed all functional tests prior to distribution. Device failure is suspected, but did not cause or contribute to a death or serious injury.
 
Event Description
The suspect lead was received by the manufacturer. Analysis of the device is underway but it has not been completed to date.
 
Event Description
It was reported that the vns patient had undergone a lead replacement due to lead discontinuity. It was reported that the impedance of the new lead was within normal ranges, dcdc code 1. Review of manufacturing records confirmed that the lead passed all functional tests prior to distribution. The explanted device has not been returned to date.
 
Event Description
Analysis of the returned portion of the lead was completed and found that the quadfilar coil 1 appeared to be broken approximately 26mm and quadfilar coil 2 appeared to be broken at approximately 30mm from the end of the cut outer-inner silicone tubes. Scanning electron microscopy was performed and identified the area as having evidence of a stress induced fracture (fatigue appearance) with mechanical damage and fine pitting on two of the broken coil strands. Pitting was observed on the coil surface. Scanning electron microscopy was performed on the detached portion from quadfilar 1 coil break (found at 26mm) and identified the area on one end as having extensive pitting which prevented identification of the coil fracture type. The areas on two of the broken coil strands, on the opposite side were identified as being mechanically damaged which prevented identification of the coil fracture type with pitting. The areas on the remaining two broken coil strands were not visible due to the positioning on the fixture. Pitting was observed on the coil surface. Scanning electron microscopy was performed on the quadfilar coil 2 coil break and identified mechanical damaged which prevented identification of the coil fracture type, no pitting and flat spots on coil surface. It is believed that stimulation was present for a certain period of time as evidenced by the presence of metal pitting. Low magnification sem analysis of the quadfilar coil shows characteristics typical of a lead discontinuity which may include: material fracture, rough or pitted surface, thinned material thickness, electro-etching or material dissolution. The puncture and slice marks and abraded openings found on the outer silicone tubing and the cut ends that were made during the explanted process, most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids found inside the outer silicone tubing. For the observed inner tubing fluid remnants, there was no obvious path for fluid ingress other than the cut ends that were made during the explanted process. What appeared to be white deposits were observed in various locations. With the exception of the observed discontinuities the condition of the returned lead portions is consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted.
 
Manufacturer Narrative
Device failure occurred, but did not cause or contribute to death or serious injury.

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« Reply #102 on: February 21, 2019, 11:32:26 AM »

Model Number 300-20
Event Date 03/02/2015
Event Type  Malfunction   
Manufacturer Narrative
Review of manufacturing records confirmed that the lead passed all functional tests prior to distribution. Device failure is suspected, but did not cause or contribute to a death or serious injury.
 
Event Description
It was reported that the vns patient underwent generator and lead replacement surgery on (b)(6) 2015 due to a reported lead fracture and battery depletion. Attempts for additional relevant information have been unsuccessful to date. The explanted devices were returned to the manufacturer. Analysis is underway, but it has not been completed to date.
 
Event Description
It was reported that the patient¿s vns system showed high impedance. It was reported that x-rays would be taken, but they have not been provided to the manufacturer to date. No known surgical interventions have occurred to date.
 
Event Description
Analysis of the lead confirmed a discontinuity of the negative quadfilar coil in the electrode region of the returned lead portions. The unmarked connector pin quadfilar coil appeared to be broken. Four broken coil strands were identified with two showing evidence of a stress induced fracture with mechanical damage and fine pitting. The area on a third was identified as being mechanically damaged. Flat spots and pitting were observed on the coil surface. It is believed that stimulation was present for a certain period of time as evidenced by the presence of metal pitting. The quadfilar coil shows characteristics typical of a lead discontinuity which may include: material fracture, rough or pitted surface, thinned material thickness, electro-etching or material dissolution. White deposits were found in various sites which contained silicon, phosphorus, sodium, magnesium, chlorine, aluminum, sulphur and calcium. With the exception of the observed discontinuity, the returned lead portion shows a condition that is consistent with an explant procedure. No other obvious anomalies were noted. Analysis of the generator found that the battery was at end of service due to normal battery depletion. The device exhibited current consumption rates that are within specification. The pulse generator module performed according to functional specifications.
 
Manufacturer Narrative
Describe event or problem ; corrected data: the previously submitted mdr inadvertently provided an incorrect event description.
 
Manufacturer Narrative
Device failure occurred, but did not cause or contribute to death or serious injury.

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« Reply #103 on: February 25, 2019, 01:21:14 AM »

Model Number 302-20
Event Date 04/14/2015
Event Type  Malfunction   
Event Description
It was reported that device diagnostics resulted in high impedance. The patient was referred for surgery. Clinic notes dated (b)(6) 2015 note that the patient has experienced a dramatic increase in seizures since the last office visit. It was noted that there was an increase in device impedance and that may be why the patient is having increased seizures. It was reported that there is no known trauma or patient manipulation that may have caused the high impedance. It was reported that the seizures were above the patient's pre-vns baseline frequency. No known surgical interventions have been performed to date.
 
Manufacturer Narrative
Device failure occurred, but did not cause or contribute to a death or serious injury.
 
Event Description
The patient underwent generator and lead replacement due to high impedance. The explanted generator and lead were received for analysis. Analysis is underway, but has not been completed to date.
 
Manufacturer Narrative

Manufacturer Narrative
Device failure is suspected, but did not cause or contribute to a death or serious injury.
 
Event Description
Product analysis of the returned generator was completed on (b)(4) 2015. The generator performed according to functional specifications. Analysis in the product analysis lab concluded proper functionality of the generator and that no abnormal performance or any other type of adverse condition was found. Analysis of the lead was completed on (b)(4) 2015. Note that the electrodes were not returned for analysis; therefore a complete evaluation could not be performed on the entire lead product. During the visual analysis the (-) connector pin quadfilar coil appeared to be broken approximately 306mm from the end of the connector boot. Scanning electron microscopy was performed and identified the area as having extensive pitting which prevented identification of the coil fracture type with residual material. Pitting was observed on the coil surface. It is believed that stimulation was present for a certain period of time as evidenced by the presence of metal pitting. Low magnification sem analysis of the quadfilar coil shows characteristics typical of a lead discontinuity which may include: material fracture, rough or pitted surface, thinned material thickness, electro-etching or material dissolution. During the visual analysis the (+) connector ring quadfilar coil appeared to be stretched and kinked approximately 273mm past the end of the cut / torn inner silicone tubes with a spot-weld / slug attached to the end. Scanning electron microscopy was performed and revealed a spot-weld / slug at the end of the coil attached to a portion of the ribbon. The abraded openings and slice mark found on the outer silicone tubing and the cut ends that were made during the explanted process, most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids found inside the outer silicone tubing. The abraded openings found on the (-) connector pin inner silicone tubing and the cut ends that were made during the explanted process, most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids found inside the inner silicone tubing. For the observed dried remnants of what appeared to have once been body fluids found inside the (+) connector ring inner silicone tubing, there was no obvious path for fluid ingress other than the cut ends that were made during the explanted process. What appeared to be white deposits were observed on the outer silicone tubing. Eds (energy dispersion spectroscopy - provides chemical or element identity/composition analysis) was performed and identified the deposit as containing silicon, phosphorus, sodium, magnesium, aluminum, sulphur and calcium. With the exception of the observed discontinuity the condition of the returned lead portion is consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted. The setscrew marks found on the lead connector pin provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portion were performed, during the visual analysis, and no other discontinuities were identified.

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« Reply #104 on: February 26, 2019, 01:21:01 AM »

Model Number 300-20
Device Problems Corroded ; Fluid Leak; Connection Problem
Event Date 05/12/2012
Event Type  Malfunction   
Event Description
Product analysis (pa) for the returned generator was completed. A comprehensive automated electrical evaluation showed the generator performed according to functional specifications, with the exception of the test "backup cap neg to can", which has already been captured in mfr. Report 1644487-2017-03534. There were no additional performance or any other type of adverse conditions found with the generator. Pa for the returned lead was completed. Allegations of lead fractures were confirmed. The electrodes were not returned for analysis; therefore, a complete evaluations could not be performed on the entire lead product. During the visual analysis, the outer silicone tubing appeared to be twisted and compressed in several areas. Fractures were identified and scanning electron microscopy found that they were stress induced fractures. Additionally, pitting was observed on the surface of some of the breaks. Abraded openings found on the outer silicone tubing most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids inside the outer silicone tubing. What appeared to be white deposits were observed in various locations. Energy dispersion spectroscopy was performed on one of the deposits and identified the deposit as containing silicon, phosphorus, sodium, magnesium, and calcium. With the exception of the observed discontinuities and the abraded openings, the condition of the returned lead portions is consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted. Based on the findings in the pa lab, there is evidence to suggest discontinuities in the returned portion of the device, which may have contributed to the stated allegations of lead fractures. Note that since the electrode array section was not returned, an evaluation and resulting commentary cannot be made on that portion of the lead.
 
Manufacturer Narrative
Manufacturer reviewed x-rays of implanted device. Review of x-rays by the manufacturer revealed a gross lead discontinuity. Device failure occurred, but did not cause or contribute to a death or serious injury.
 
Event Description
It was reported the patient has been referred for replacement surgery; however, no surgical intervention has taken place to date.
 
Event Description
Clinic notes dated (b)(6) 2015 note that the patient and her mother feel that the vns was injured or disconnected the year prior and that device diagnostics were within normal limits. It was noted that there was a tightness in the lead that the neurologist was concerned about. The surgeon noted that there is no unusual tightness of the lead. An x-rays assessment was received indicating that the lead wire was disconnected from the device in the left neck. It was reported that device diagnostics performed on (b)(6) 2014 were within normal limits (1704 ohms). The neurologist believes that scar tissue is the reason for the lead tightness feeling that the patient experiences. The neurologist indicated that the patient's parents have asked for the generator and lead to be replaced. X-rays were sent to manufacturer for review. X-rays identified that the lead appeared to be fractured near the electrodes. It was later reported that high impedance was observed and that revision surgery was planned. A fluoroscopy was performed by the surgeon who found that the lead could not be seen clearly and concluded that the lead may have never been connected. Recent diagnostics were found in the physician's programming system that showed that device diagnostics were within normal limits at one time which showed that the device was at one time connected. The patient was seen on (b)(6) 2015 at which time device diagnostics were within normal limits. It was reported that the device was functioning normally and was programmed back on. The cause of the diagnostics being within normal limits is a believed short circuit situation with the patient's tissue. A device decoder was performed which identified that the lead break likely occurred as early as (b)(6) 2012. The patient was referred back to surgeon. No known surgical interventions have occurred to date.
 
Manufacturer Narrative
Age at time of event; corrected data: this information was inadvertently reported incorrectly on initial mfr. Report.
 
Event Description
The explanted generator and lead were received by the manufacturer on 03/02/2017. While analysis is expected, it has not been completed to date.
 
Event Description
Additional x-rays were sent to the manufacturer for review. X-rays identified that the lead appeared to be fractured near the electrodes confirming a lead break.
 
Event Description
The patient underwent a full vns revision on (b)(6) 2016. It was noted when the lead was removed, it appeared to be fractured and the lead wires were twisted together. Attempts for additional relevant information have been unsuccessful to date.

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« Reply #105 on: March 13, 2019, 12:23:01 AM »

Model Number 300-20
Device Problems Break; Calcified
Event Date 08/05/2015
Event Type  Malfunction   
Event Description
Product analysis for the returned lead was completed. It was noted that a portion of the lead assembly, including the electrodes, was not returned for analysis. White deposits were observed in various locations. The deposits were analyzed with energy dispersion spectroscopy which identified silicon, phosphorus, sodium, magnesium, and calcium. During visual analysis, three areas of the coil strands were identified as having the appearance of being melted, with re-solidified material. Based on obvious signs of mechanical damage on the coil surface, it is possible the thermally-damaged coil was exposed to a high temperature device such as a cauterizing tool during the explant of the lead. There were also two stress-related fractures noted on the lead. The stress fractures were due to rotational forces, which most likely completed the fracture with mechanical damage. A third region of the coil appeared to be stretched, kinked, and extended past the end of the cut/torn outer and inner silicon tubes. Determination could not be made if the end was cut. The condition of the returned lead portion is consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted except for the set of setscrew marks found near the end of the marked connector pin, indicating the lead had not been fully inserted into the cavity of the generator at one time. However, additional setscrew marks found on the connector pin provide evidence that, at one point in time, a good mechanical and electrical connection was present. The setscrew marks on the unmarked connector pin provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portions were performed, during the visual analysis, and no discontinuity was identified. Based on the findings in the product analysis lab, there is no evidence to suggest a discontinuity in the returned portions of the lead.
 
Event Description
Both the lead and the generator were received by the manufacturer. Product analysis for the returned vns generator showed the generator was noted to perform according to functional specifications. Analysis of the vns generator in the product analysis lab concluded that no abnormal performance or any other type of adverse condition was found. Product analysis for the lead is expected but has not been completed to date.
 
Event Description
It was reported the lead was found encapsulated by calcification at the site of the vns generator. When the generator was removed from the pocket, the lead was found to be damaged. Due to the lead damage, the lead was replaced. It was reported the vns device was tested during the pre-operative evaluation and no high impedance was noted. The suspect device is expected to be returned, but has not been received to date.
 
Manufacturer Narrative
Evaluation, results and conclusions; corrected data: this information was inadvertently left off of the supplemental #02 mfr. Report.

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« Reply #106 on: March 14, 2019, 03:55:15 AM »

Model Number 302-20
Device Problem Kinked
Event Date 09/28/2015
Event Type  Malfunction   
Event Description
It was reported the lead was replaced due to an observed kink during surgery. The vns generator was replaced due to normal battery depletion. Both the lead and the generator were received for analysis. Analysis is expected, but has not been completed to date. Attempts for additional relevant information have been unsuccessful to date.
 
Event Description
Product analysis for the generator was completed. It was found that the generator was at the eos (end of service) condition. The depletion was an expected event as determined by the battery life calculation and the battery voltage measurement. There device performed according to specifications.
 
Event Description
Product analysis was completed on the returned portion of the lead. Analysis of the returned portion of the lead determined that the report of a kinked lead was not verified. However, a large portion of the lead assembly (body), including the electrodes, was not returned for analysis; therefore, a complete evaluation could not be performed on the entire lead product. The abraded opening found on the outer silicone tubing and the cut ends that were made during the explant process most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids inside the outer silicone tubing. For the observed inner tubing fluid remnants, there was no obvious path for fluid ingress other than the cut ends that were made during the explant process. What appeared to be white deposits were observed in various locations. Chemical analysis was performed on the deposit observed on the outer silicone tubing and identified the deposit as containing silicone. The condition of the returned lead portion is consistent with conditions that typically exist following an explant procedure. No obvious anomalies were noted. The setscrew marks found on the lead connector pins provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portion were performed and no discontinuities were identified. Based on the findings in the product analysis lab, there is no evidence to suggest an anomaly with the returned portion of the device.

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« Reply #107 on: March 14, 2019, 03:56:14 AM »

Model Number 102
Device Problem Entrapment of Device
Event Date 09/21/2015
Event Type  Malfunction   
Manufacturer Narrative
 
Event Description
It was reported that during a near end-of-service battery replacement surgery, a calcified tissue was identified on the upper right portion of the generator can, below the header. The surgeon suspected that the area with calcification was a result of corrosion. The calcified tissue was chipped away from the generator. Systems diagnostics at pre-surgery and during surgery were reported to be within normal limits. There was no tissue located at the header or the welded seam of the generator can. No infection was noted in the area. The product has been received for analysis, which has not been completed to-date.
 
Event Description
Analysis was completed on the returned generator. Other than typical explant procedure related observations, no surface abnormalities, such as sharp edges, header delamination, open pockets, decomposition, corrosion, or voids were noted on this device. There were white deposits on the can. A scanning electron microscopy analysis of the foreign matter indicated that it was calcium and phosphorus. There was no evidence of dried body fluid or corrosion in the connector block. There was no indication from the device that an end of service condition existed. A battery life calculation resulted in 0. 50 years remaining before the elective replacement indicator flag would be set. Analysis of the generator concluded that no abnormal performance or any other type of adverse condition was found.

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« Reply #108 on: March 14, 2019, 03:57:03 AM »

Model Number 302-20
Device Problem High impedance
Event Date 10/06/2015
Event Type  Malfunction   
Event Description
It was reported that vns device diagnostics resulted in high impedance. A dc-dc code 7 was observed during the normal mode and system mode diagnostic tests. No patient adverse events were reported. It was reported that the patient's device was turned off on (b)(6) 2015. No known surgical interventions have been performed to date. No additional relevant information has been received to date.
 
Event Description
Further information was received indicating that the patient underwent full revision surgery on (b)(6) 2015. It was reported that the lead was replaced due to lead break and the generator was prophylactically replaced. The patient's vns system was tested upon connection of the new lead to the existing generator and system diagnostics returned impedance results within normal limits. Return of the explanted lead to the manufacturer is expected but it has not been received to date. Review of manufacturing records confirmed that the lead passed all functional tests prior to distribution.
 
Event Description
The explanted lead was returned to the manufacturer on (b)(6) 2015. Analysis is underway but it has not been completed to date.
 
Event Description
Analysis was completed on the returned lead portions and the reported allegations was confirmed. Note that the anchor tether, portions of the (+) white and (-) green electrode inner silicone tubes and quadfilar coils were not returned for analysis; therefore a complete evaluation could not be performed on the entire lead product. During the visual analysis of the returned 417mm portion the end of the connector ring quadfilar coil appeared to be broken approximately 12mm from the electrode bifurcation. Scanning electron microscopy was performed and identified the area on three of the broken coil strands as having extensive pitting which prevented identification of the coil fracture type with residual material. The remaining broken coil strands was identified as being mechanically damaged (smooth surfaces) with pitting which prevented identification of the coil fracture type. Pitting was observed on the coil surface. It is believed that stimulation was present for a certain period of time as evidenced by the presence of metal pitting. Low magnification sem analysis of the quadfilar coil shows characteristics typical of a lead discontinuity which may include: material fracture, rough or pitted surface, thinned material thickness, electro-etching or material dissolution. The abraded openings found on the outer silicone tubing, most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids inside the outer silicone tubing. What appeared to be white deposits were observed on the inner silicone tubing of the returned 14mm portion. Energy dispersion spectroscopy was performed on the deposit and identified the deposit as containing silicon, phosphorus, sodium and calcium. With the exception of the observed discontinuity the condition of the returned lead portions is consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted except for the set of setscrew marks found near the end of the connector pin indicating the lead had not been fully inserted into the cavity of the generator. The additional setscrew marks found on the lead connector pin provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portions were performed, during the visual analysis, with no discontinuities identified.

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« Reply #109 on: March 16, 2019, 12:15:20 AM »

Model Number 302-30
Device Problems Break; High impedance
Event Date 05/17/2015
Event Type  Malfunction   
Event Description
It was reported by the neurologist the patient was scheduled for vns surgery as the vns was checked showing high impedance and it is unsure if the lead pin is out or if a new lead needs to be placed. It was also reported the patient's device was turned off on (b)(6) 2015. It was later reported the patient underwent surgery on (b)(6) 2015 and the lead and the generator were both replaced. The lead was replace due to high impedance and the generator was prophylactically replaced. Additionally, it was reported there was a lead break at the strain relief bend, right by the tie down. It was also clarified the generator was replaced prophylactically as the physicians were unclear how long the device had been broken and were not comfortable using the old device due to the broken lead and risk of infection from taking the generator out, then putting it back in after removing and replacing with the new lead. The lead and the generator were received. Analysis is expected but has not been completed to date.
 
Event Description
Product analysis found that the high impedance most likely occurred on (b)(6) 2015 as the impedance value was noted to have changed from 1224 ohms to 11619 ohms on that date. It was found through testing that the generator performed according to functional specifications. The final electrical test shows and ifi = no condition. There were no performance or any other type of adverse conditions found with the pulse generator. Analysis was completed on the returned lead portions and lead fractures were confirmed. It should be noted that portions of the electrodes were not returned for analysis; therefore a complete evaluation could not be performed on the entire lead product. Fractures were found on all three coil strands. One of the coils had extensive pitting that prevented identification of the fracture type. It was noted that all three broken coil strands were mechanically damaged which prevent identification of the fracture type, with evidence of a stress induced fracture, which most likely completed the fracture on all three broken coil strands. One of the coil strands was identified as having evidence of a stress induced fracture with mechanical damage and pitting. Determination could not conclusively be made on the fracture mechanism. It is believed that stimulation was present for a certain period of time as evidenced by the presence of metal pitting. The abraded openings found on the outer silicone most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids inside the outer silicone tubing. White deposits were observed in various locations. Energy dispersion spectroscopy was performed on the deposit observed on the connector boot and identified the deposit as containing silicon, phosphorus, sodium, magnesium, and calcium. It was found that the returned white electrode ribbon appeared to be embedded in what appeared to be remnants of dried body tissue. This condition may have prevented the white electrode ribbon from coming in contact with the vagus nerve. With exception of the observed discontinuities and the tissue covered white electrode ribbon, the condition of the returned lead portions is consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted. The setscrew marks found on the lead connector pin provide evidence that, at one point in time, a good mechanical and electrical connection was present. Based on the findings in the product analysis lab, there is evidence to suggest discontinuities in the returned portions of the lead which may have contributed to the stated allegations.
 
Manufacturer Narrative
This information was inadvertently left off of supplemental #01 mfr. Report.

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« Reply #110 on: March 19, 2019, 12:23:52 AM »

Model Number 300-20
Device Problem High impedance
Event Date 01/01/2015
Event Type  Malfunction   
Event Description
It was reported that the patient was admitted to the hospital due to an increase in seizures. A system diagnostic test was later performed for patient and high impedance with dcdc 7 was observed. Additional information was obtained that the patient was discharged then re-admitted due to a generalized seizure. Patient was referred for replacement surgery and underwent full revision surgery on (b)(6) 2015. The explanted products are expected to be returned but have not been received to date.
 
Event Description
Generator and lead were returned due to lead discontinuity and were received on 11/30/2015. The generator performed according to functional specifications. During the product analysis, there were no anomalies found with the pulse generator. Analysis of the lead is underway but has not been completed.
 
Event Description
An analysis was performed on the returned lead portions and the reported allegations of ¿fracture of leads and high impedance¿ were confirmed. A portion of inner silicone tubing and quadfilar coil between the electrode bifurcation and anchor tether was not returned for analysis; therefore, a complete evaluation could not be performed on the entire lead product. Analysis confirmed discontinuity of both positive and negative quadfilar coils in the electrode region of the returned lead portions. Scanning electron microscopy was performed on the area of the break on quadfilar coil 1; the remaining coil strand was identified as having evidence of a stress induced fracture (fatigue appearance) with mechanical damage, no pitting and evidence of a stress induced fracture (rotational forces) which most likely completed the fracture. Flat spots and pitting was observed on the coil surface. Scanning electron microscopy was performed on the quadfilar coil 2 coil break area and the area was identified as having extensive pitting which prevented identification of the coil fracture type. Flat spots and pitting was observed on the coil surface. It is believed that stimulation was present for a certain period of time as evidenced by the presence of metal pitting. Low magnification sem analysis of the quadfilar coil shows characteristics typical of a lead discontinuity which may include: material fracture, rough or pitted surface, thinned material thickness, electro-etching or material dissolution. The abraded opening found on the outer silicone tubing, most likely provided the leakage path for the dried remnants of what appeared to have once been body fluids inside the outer silicone tubing. What appeared to be white deposits were observed in various locations. Eds (energy dispersion spectroscopy ¿ provides chemical or element identity/composition analysis) was performed on the deposit observed on the outer silicone tubing and identified the deposit as containing silicon, phosphorus, sodium, magnesium, sulphur and calcium. Refer to attached eds sheet for additional information. With the exception of the observed discontinuities the condition of the returned lead portions is consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted. The setscrew marks found on the lead connector pins provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portions were performed, during the visual analysis, and no other discontinuities were identified.

https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=5246076
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dennis100
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« Reply #111 on: March 23, 2019, 12:15:08 AM »

Model Number 302-20
Device Problem High impedance
Event Date 11/23/2015
Event Type  Malfunction   
Event Description
It was reported that high impedance was observed on vns patient's system on (b)(6) 2015. It was reported that the patient underwent generator replacement surgery on (b)(6) 2015 for prophylactic reasons. The diagnostic results in or and since have been good (dcdc 2), until on (b)(6) 2015 where the normal and system diagnostic testing showed high impedance (dcdc 7). X-rays were taken and sent to the manufacturer for review. The generator appears to be placed in the upper chest in normal arrangement. The pin connector is fully inserted. The electrodes appeared to be placed in normal arrangement. Strain-relief bend and loop seemed to have been used. One tie-down was found (visible) holding the lead but not as specified in labeling. A portion of lead behind the generator could not be assessed. No suspected lead break was found on the visible part of the lead. It was reported that the device was turned off on (b)(6) 2015. Review of manufacturing records confirmed that both, the generator and the lead passed all functional tests prior to distribution. No known surgical interventions have been performed to date. No additional relevant information has been received to date.
 
Event Description
Further information was received indicating that the patient underwent full revision surgery on (b)(6) 2015. The patient's vns system was tested upon connection of the new lead to the new generator and system diagnostics returned impedance results within normal limits with was 1345 ohms. It was reported that the generator was replaced due a generator issue. This event is reported in the medwatch number 1644487-2016-00042. Return of the explanted devices to the manufacturer is expected but they have not been received to date.
 
Event Description
The explanted lead was returned to the manufacturer on 01/08/2016. Analysis of the returned lead portions was completed and the reported allegations were confirmed. During the visual analysis of the returned 218mm portion quadfilar coil 2 appeared to be broken approximately 194mm from the end of the cut outer / inner silicone tubes. Scanning electron microscopy (sem) was performed on the connector end of the quadfilar coil 2 coil break (found at 194mm) and identified the area on two of the broken coil strands as having evidence of a stress induced fracture (fatigue appearance) with mechanical damage, no pitting and evidence of a stress induced fracture (rotational forces) which most likely completed the fracture on one of the broken coil strands. The area on the remaining broken coil strands was identified as having evidence of a stress induced fracture with mechanical damage and no pitting. Determination could not conclusively be made on the fracture mechanism. Flat spots were observed on the coil surface. Sem was performed on the electrode (mating) end of the quadfilar coil 2 coil break (found at 194mm) and identified the area as being mechanically damaged (smooth surfaces) which prevented identification of the coil fracture type. Flat spots and pitting were observed on the coil surface. It is believed that stimulation was present for a certain period of time as evidenced by the presence of metal pitting. Low magnification sem analysis of the quadfilar coil shows characteristics typical of a lead discontinuity which may include: material fracture, rough or pitted surface, thinned material thickness, electro-etching or material dissolution. What appeared to be white deposits were observed in various locations. Eds (energy dispersion spectroscopy provides chemical or element identity/composition analysis) was performed on the deposit observed on the connector boot and identified the deposit as containing silicon, phosphorus, sodium, magnesium and calcium. With the exception of the observed discontinuity the condition of the returned lead portions is consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted. The setscrew marks found on the lead connector pin provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portions were performed, during the visual analysis, and no other discontinuities were identified. Based on the findings in the product analysis lab, there is evidence to suggest a discontinuity in the returned portions of the device which may have contributed to the stated allegations.

https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=5297221
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dennis100
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« Reply #112 on: March 24, 2019, 01:18:06 AM »

Model Number 302-20
Device Problems Corroded ; Fluid Leak; High impedance
Event Date 11/11/2015
Event Type  Malfunction   
Event Description
It was reported on 11/11/2015 that the patient had an end of service replacement that day. The physician was unable to interrogate the generator. When the new generator was connected to the existing lead, high impedance was observed around 8000 ohms. The lead was disconnected and reinserted. The physician verified that the lead pin was advanced beyond the connector block and the set screw was tightened down. Impedance was measured again and the value was over 8000 ohms. The surgeon was not able to replace the lead that day. The old lead remained connected to the new generator and the generator was left at 0. 0 ma. The explanted generator was discarded after surgery. Replacement of the lead is expected but has not been completed to date.
 
Event Description
It was reported on (b)(6) 2015 that the patient had a follow-up appointment on (b)(6) 2015 and the patient no longer has high impedance. Since intermittent impedance or a microfracture cannot be ruled out, the patient's device may still be malfunctioning. No additional relevant information has been received to date.
 
Event Description
Programming history database was reviewed on (b)(6) 2016 for the recently received model 106 generator data. History was available from date of implant, (b)(6) 2015. The system diagnostics were performed 5 times and each time resulted in high impedance. (b)(6) 2015: 8:41:57 am - ok/ok/8894/ok; (b)(6) 2015: 8:43:15 am - ok/ok/8523/ok; (b)(6) 2015: 8:47:17 am - ok/ok/9039/ok; (b)(6) 2015: 8:55:56 am - ok/ok/9026/ok; (b)(6) 2015: 8:56:38 am - ok/ok/5980/ok.
 
Event Description
Information was received 08/08/2017 that the patient¿s device was found to have high impedance in the 6,000 ohms range. X-rays were received and reviewed but could not conclusively identify a cause of the high impedance.
 
Event Description
X-rays were received and review showed there is a sharp angle in the lead body observed just proximal from the generator implant site. Full revision surgery occurred. Impedance was high in pre-op. The surgeon removed the battery and re-inserted the pin but the impedance was still high. The battery was tested alone with the test resistor, and the impedance was within normal limits. The explanted devices have not been received by the manufacturer to-date.
 
Event Description
Further information was received that both the generator and lead were returned to the manufacturer. Product analysis was completed on both products. Analysis on the generator did not find any anomalies. The generator performed according to all specifications, and besides markings associated with explant, no visual abnormalities were noted. Data from the generator was also reviewed. High impedance was seen on the day of explant. Product analysis on the lead identified multiple coil breaks along the returned lead body. Scanning electron microscopy was performed and identified some areas as being mechanically damaged which prevented identification of the coil fracture type. Scanning electron microscopy also identified some of the fractures of being stress induced by fatigue or rotational stress. Pitting was also observed on some of the various broken coils indicating stimulation was likely present at one point. Residual material was observed on one of these broken coils. Multiple abraded openings were also noted on the outer tubing. There were also areas of abraded openings in the inner tubing near some of the fractures. This allowed fluid to breach the inner and outer tubing. White deposits were also noted along the lead body. With the exception of the observed abraded openings and discontinuities the condition of the returned lead portions was consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted. The setscrew marks found on the lead connector pin provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portions were performed, during the visual analysis, and no other discontinuities were identified. The electrodes were not returned and analysis could not be completed on that portion of the lead. No further relevant information has been received.

https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=5260887
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dennis100
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« Reply #113 on: March 24, 2019, 01:19:05 AM »

Model Number 302-20
Device Problem High impedance
Event Date 10/23/2015
Event Type  Malfunction   
Event Description
It was reported on (b)(6) 2015 that the patient had an appointment that day and system diagnostics were run with results of high impedance. The device was programmed off the day the high impedance was observed. No x-rays are scheduled at this time. They do not suspect that there was any trauma or manipulation. The patient had a full replacement on (b)(6) 2015. It was reported that the negative electrode was detached from the lead. Attempts for product return have been made, but the explanted device has not been received to date.
 
Event Description
Information received on 12/01/2015 indicated that the explanted device was discarded after surgery and is therefore unavailable for analysis.
 
Event Description
Generator and lead were received for analysis on 02/10/2016. Product analysis for the generator was completed and approved on 02/29/2016. From the generator decoder received from the device, the change in impedance from 5058 ohms to 6448 ohms occurred on (b)(6) 2015. In the lab, the device output signal was monitored for more than 24-hrs, while the generator was placed in a simulated body temperature environment. Results showed no signs of variation in the pulse generator's output signal and demonstrated that the device provided the expected level of output current for the entire monitoring period. There were no performance or any other type of adverse conditions found with the pulse generator. Product analysis for the lead has not been completed to date.
 
Event Description
Product analysis for the lead was completed and approved on 03/07/2016. Note that portions of the (+) white and (-) green electrode quadfilar coils, the anchor tether and (-) green electrode were not returned for analysis and therefore a complete evaluation could not be performed on the entire lead product. What appeared to be white deposits were observed on one of the inner silicone tubes. The condition of the returned lead portions is consistent with conditions that typically exist following an explant procedure. No obvious anomalies were noted. The setscrew marks found on the connector pin provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portions were performed, during the visual analysis, and no discontinuities were identified. Based on the findings in the product analysis lab, there is no evidence to suggest discontinuities in the returned portions of the device.
 
Manufacturer Narrative

Event Description
Based on findings from product analysis, no evidence of corrosion was found on the patient's lead. The figures provided show a heavily manipulated lead (suggestive that the patient was a twiddler).
 
Manufacturer Narrative
Describe event, corrected data. Supplemental mdr #5 incorrectly reported information that was inaccurate.
 
Event Description
Re-evaluation of the product analysis results revealed that the manipulation of the lead was attributed to the explant-related events and is not believed to have contributed to the high impedance during implant.

https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=5263683
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« Reply #114 on: Today at 12:17:50 AM »

Model Number 304-20
Device Problems Disconnection; Low impedance; Lead
Event Date 12/21/2015
Event Type  Malfunction   
Event Description
Low impedance was reported to be observed on the patient's vns device. The patient was referred for revision surgery due to the observed decrease in impedance. There was no trauma reported that could have caused or contributed to the low impedance and there were no reported adverse events. The patient underwent revision surgery on (b)(6) 2016. During the surgery, the surgeon observed a lead discontinuity near the generator site. Attempts for additional relevant information were unsuccessful to date.
 
Event Description
Product analysis for the returned generator demonstrated that accurate resistance measurements were obtained in all instance using various electrical loads. A comprehensive automated electrical evaluation showed that the vns generator performed according to functional specifications. The final electrical test showed an ifi = no condition. There were no performance or any other type of adverse conditions found with the vns generator. Product analysis for the returned lead found abraded an opening on the inner silicone tube, in one locations, and abraded openings on the outer silicone tube. The abraded opening on the outer tubing and the cut ends made during the explant process most likely provided the leakage path for the dried remnants of what appeared to have been body fluids found inside the outer tubing. What appeared to be white deposits were observed in various locations. Energy dispersion spectroscopy was performed on the deposits observed on the connector boot and identified the deposit as containing silicon and sodium. With the exception of the abraded openings, the condition of the returned lead portions is consistent with those that typically exist following an explant procedure. No other obvious anomalies were noted. The setscrew marks found on the lead connector pin provide the evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portions were performed during visual analysis and no discontinuities were identified. Based on these findings in the product analysis lab, there was no evidence to support the low impedance, short circuit, or fractured lead allegations. It should be noted that a portion of the lead assembly, including the electrodes, was not returned for analysis; therefore, a complete evaluation could not be performed on the entire lead product.
 
Event Description
It was also reported the patient had an increase in seizures, above pre-vns baseline levels, which began after the lead fracture occurred. The increased seizures continued once the new devices were implanted and was reported, and will continue to be investigated, in mfr. Report 1644487-2016-01782.

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« Reply #115 on: Today at 12:18:45 AM »

Model Number 302-20
Device Problem High impedance
Event Date 07/01/2015
Event Type  Malfunction   
Manufacturer Narrative

Event Description
It was reported that the patient's vns device was showing high lead impedance upon interrogation. It was reported that the patient experienced a breakthrough seizure in (b)(6) 2015, after previously having been seizure free. The physician assessed this increase in seizures to a loss of therapy from the high impedance. No known surgical interventions have occurred to date. No additional relevant information has been received to date.
 
Event Description
Additional information was received via clinic notes that this patient's vns impedance was reportedly normal during initial implant in 2011. No additional relevant information has been obtained to date.
 
Event Description
Patient underwent full revision surgery on (b)(6) 2016. The explanted devices were received on (b)(6) 2016. Analysis is underway but has not been completed.
 
Event Description
An analysis was performed on the returned lead portions and the reported allegations of fracture of leads was confirmed. The electrodes were not returned for analysis; therefore a complete evaluation could not be performed on the entire lead product. Visual analysis and scanning electron microscopy confirmed two broken coil strands as having extensive pitting. The area on a third broken coil strand was identified as being mechanically damaged with pitting which prevented identification of the coil fracture type. The area on the fourth broken coil strand was identified as having evidence of being worn to the point of fracture with flat spots on the coil surface. Pitting and flat spots were observed on the coil surface. Multiple areas on the broken coil strands had evidence of a stress induced fracture (fatigue appearance) with mechanical damage and pitting. It is believed that stimulation was present for a certain period of time as evidenced by the presence of metal pitting. Low magnification sem analysis of the quadfilar coil shows characteristics typical of a lead discontinuity which may include: material fracture, rough or pitted surface, thinned material thickness, electro-etching or material dissolution. An abraded inner tubing opening near the break location was also observed. What appeared to be white deposits were observed on the connector boot. Eds (energy dispersion spectroscopy - provides chemical or element identity/composition analysis) was performed and identified the deposit as containing silicon, phosphorus, sodium, magnesium and calcium. With the exception of the observed discontinuity the condition of the returned lead portions is consistent with conditions that typically exist following an explant procedure. No other obvious anomalies were noted except for the half set of setscrew marks found near the end of the connector pin indicating the lead had not been fully inserted into the cavity of the generator. The additional setscrew marks found on the lead connector pin provide evidence that, at one point in time, a good mechanical and electrical connection was present. Continuity checks of the returned lead portions were performed, during the visual analysis, and no other discontinuities were identified. In the (b)(4) lab, the device output signal was monitored for more than 24-hrs, while the generator was placed in a simulated body temperature environment. Results showed no signs of variation in the pulse generator's output signal and demonstrated that the device provided the expected level of output current for the entire monitoring period. The pulse generator diagnostics were as expected for the programmed parameters. In addition, a comprehensive automated electrical evaluation showed that the pulse generator performed according to functional specifications.

https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=5375035
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