FDA Adverse Event Injury Summary report: N

VERCISE GENUS¿

MDR report key: 13259958 · Received January 14, 2022

Report

Report Number
3006630150-2022-00056
Event Type
Injury
Date Received
January 14, 2022
Date of Event
January 4, 2022
Report Date
October 18, 2023
Manufacturer
BOSTON SCIENTIFIC NEUROMODULATION
Product Code
NHL
UDI-DI
08714729985044
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
GA, US
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

ADDITIONAL SUSPECT MEDICAL DEVICE COMPONENTS INVOLVED IN THE EVENT. PRODUCT FAMILY DBS-LINEAR LEADS. UPN M365DB2202450. MODEL DB-2202-45. SERIAL-LOT (B)(6). BATCH 7081104 AND 7087826. PRODUCT FAMILY DBS-EXTENSION. UPN M365NM3138550. MODEL NM-3138-55. SERIAL-LOT (B)(6). BATCH 7091731 AND 7091740.

Additional Manufacturer Narrative · 0

CORRECTION TO EMDR FOLLOW UP 2 IN BLOCK B5. ADDITIONAL SUSPECT MEDICAL DEVICE COMPONENTS INVOLVED IN THE EVENT. PRODUCT FAMILY DBS-LINEAR LEADS, UPN M365DB2202450, MODEL DB-2202-45, SERIAL-LOT (B)(6), BATCH 7081104 AND 7087826. PRODUCT FAMILY DBS-EXTENSION, UPN M365NM3138550, MODEL NM-3138-55, SERIAL-LOT (B)(6), BATCH 7091731 AND 7091740.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT EXPERIENCED REDNESS AND SWELLING AROUND THE IMPLANTABLE PULSE GENERATOR SITE. THE PATIENT WAS ADMITTED TO THE HOSPITAL DUE TO INFECTION AND UNDERWENT AN EXPLANT PROCEDURE.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT EXPERIENCED REDNESS AND SWELLING AROUND THE IMPLANTABLE PULSE GENERATOR SITE. THE PATIENT WAS ADMITTED TO THE HOSPITAL DUE TO INFECTION AND UNDERWENT AN EXPLANT PROCEDURE. ADDITIONAL INFORMATION WAS RECEIVED THAT THE PATIENT WAS ADMINISTERED ANTIBIOTICS. IT WAS ALSO REPORTED THAT THE REMAINING DEVICES WOULD BE EXPLANTED, HOWEVER THIS COULD NOT BE CONFIRMED DESPITE GOOD FAITH EFFORTS. ADDITIONAL INFORMATION WAS RECEIVED THAT DURING THE IPG EXPLANT PROCEDURE, THE LEAD EXTENSIONS WERE ALSO EXPLANTED, AND THE PROCEDURE OCCURRED ON (B)(6) 2023 NOT (B)(6) 2022. ADDITIONAL INFORMATION WAS ALSO RECEIVED THAT THE PATIENT UNDERWENT A SECOND PROCEDURE ON (B)(6) 2022 IN WHICH THE REMAINING LEADS WERE EXPLANTED FOR AN UNKNOWN REASON. THE EXPLANTED DEVICES WILL NOT BE RETURNED AS THERE WAS NO BOSTON SCIENTIFIC REPRESENTATIVE PRESENT DURING THE PROCEDURES. NO FURTHER INFORMATION CAN BE OBTAINED DESPITE GOOD FAITH EFFORTS. NO ADDITIONAL ADVERSE PATIENT EFFECTS WERE REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT EXPERIENCED REDNESS AND SWELLING AROUND THE IMPLANTABLE PULSE GENERATOR SITE. THE PATIENT WAS ADMITTED TO THE HOSPITAL DUE TO INFECTION AND UNDERWENT AN EXPLANT PROCEDURE. ADDITIONAL INFORMATION WAS RECEIVED THAT THE PATIENT WAS ADMINISTERED ANTIBIOTICS. IT WAS ALSO REPORTED THAT THE REMAINING DEVICES WOULD BE EXPLANTED, HOWEVER THIS COULD NOT BE CONFIRMED DESPITE GOOD FAITH EFFORTS. ADDITIONAL INFORMATION WAS RECEIVED THAT DURING THE IPG EXPLANT PROCEDURE, THE LEAD EXTENSIONS WERE ALSO EXPLANTED, AND THE PROCEDURE OCCURRED ON (B)(6) 2022. ADDITIONAL INFORMATION WAS ALSO RECEIVED THAT THE PATIENT UNDERWENT A SECOND PROCEDURE ON (B)(6) 2022 IN WHICH THE REMAINING LEADS WERE EXPLANTED FOR AN UNKNOWN REASON. THE EXPLANTED DEVICES WILL NOT BE RETURNED AS THERE WAS NO BOSTON SCIENTIFIC REPRESENTATIVE PRESENT DURING THE PROCEDURES. NO FURTHER INFORMATION CAN BE OBTAINED DESPITE GOOD FAITH EFFORTS. NO ADDITIONAL ADVERSE PATIENT EFFECTS WERE REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT EXPERIENCED REDNESS AND SWELLING AROUND THE IMPLANTABLE PULSE GENERATOR SITE. THE PATIENT WAS ADMITTED TO THE HOSPITAL DUE TO INFECTION AND UNDERWENT AN EXPLANT PROCEDURE. ADDITIONAL INFORMATION WAS RECEIVED THAT THE PATIENT WAS ADMINISTERED ANTIBIOTICS. IT WAS ALSO REPORTED THAT THE REMAINING DEVICES WOULD BE EXPLANTED, HOWEVER THIS COULD NOT BE CONFIRMED DESPITE GOOD FAITH EFFORTS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
807779 VERCISE GENUS¿ STIMULATOR, ELECTRICAL, IMPLANTED, FOR PARKINSONIAN SYMPTOMS NHL BOSTON SCIENTIFIC NEUROMODULATION DB-1216 523404 08714729985044

Patients

Seq Age Sex Outcome Treatment
1 61 YR Male Hospitalization| R