BEUDAMED
    FDA Adverse Event Injury Summary report: N

    VERCISE GENUS

    MDR report key: 20433243 · Received October 11, 2024

    Report

    Report Number
    3006630150-2024-06881
    Event Type
    Injury
    Date Received
    October 11, 2024
    Date of Event
    September 1, 2024
    Report Date
    October 11, 2024
    Manufacturer
    BOSTON SCIENTIFIC NEUROMODULATION
    Product Code
    NHL
    UDI-DI
    08714729985044
    PMA / PMN Number
    P150031
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MI, US
    Reporter Occupation
    PHYSICIAN
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    ADDITIONAL SUSPECT MEDICAL DEVICE COMPONENTS INVOLVED IN THE EVENT: PRODUCT FAMILY: DBS-EXTENSION. UPN: M365NM3138550. MODEL: NM-3138-55. SERIAL: (B)(6). BATCH: 7110878. PRODUCT FAMILY: DBS-EXTENSION. UPN: M365NM3138550. MODEL: NM-3138-55. SERIAL: (B)(6). BATCH: 7110136.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT THE DEEP BRAIN STIMULATION (DBS) PATIENT EXPERIENCED PAIN AND DISCOMFORT CAUSED BY THE IMPLANTABLE PULSE GENERATOR (IPG) FLIPPING OVER IN THE POCKET. THE PATIENT UNDERWENT A REVISION PROCEDURE WHERE THE IPG WAS REPOSITIONED, AND THE LEAD EXTENSIONS WERE REPLACED. THE PATIENT WAS DOING WELL POST-OPERATIVELY. THE EXPLANTED LEAD EXTENSIONS WERE DISCARDED BY THE MEDICAL FACILITY AND WERE NOT RETURNED TO BSC.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    336466 VERCISE GENUS STIMULATOR, ELECTRICAL, IMPLANTED, FOR PARKINSONIAN SYMPTOMS NHL BOSTON SCIENTIFIC NEUROMODULATION DB-1216 562277 08714729985044

    Patients

    Seq Age Sex Outcome Treatment
    1 53 YR Female Required Intervention