FDA Adverse Event Injury Summary report: N

VERCISE GENUS?

MDR report key: 20529549 · Received October 24, 2024

Report

Report Number
3006630150-2024-07305
Event Type
Injury
Date Received
October 24, 2024
Date of Event
September 27, 2024
Report Date
May 26, 2026
Manufacturer
BOSTON SCIENTIFIC NEUROMODULATION CORPORATION
Product Code
MHY
UDI-DI
08714729985044
PMA / PMN Number
P150031
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
WA, 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: (B)(6). BATCH: 7123134. PRODUCT FAMILY: DBS-LINEAR LEADS. UPN: M365DB2202450. MODEL: DB-2202-45. SERIAL: (B)(6). BATCH: 7123470. PRODUCT FAMILY: DBS-EXTENSION. UPN: M365NM3138550. MODEL: NM-3138-55. SERIAL: (B)(6). BATCH: 7130026 PRODUCT FAMILY: DBS-EXTENSION. UPN: M365NM3138550. MODEL: NM-3138-55. SERIAL: (B)(6). BATCH: 7129881. PRODUCT FAMILY: DBS-LEAD FIXATION. UPN: M365DB4600C0. MODEL: DB-4600C. SERIAL: NULL. BATCH: 34153618. PRODUCT FAMILY: DBS-LEAD FIXATION. UPN: M365DB4600C0. MODEL: DB-4600C. SERIAL: (B)(6). BATCH: 34153618.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE DEEP BRAIN STIMULATION (DBS) PATIENT EXPERIENCED AN INFECTION AND PRESENTED WITH SYMPTOMS OF CONFUSION. THE PATIENT WAS ADMITTED TO THE HOSPITAL AND UNDERWENT A REVISION PROCEDURE WHERE THE WHOLE SYSTEM WAS EXPLANTED. THE PATIENT WAS TREATED WITH MEDICATION BUT IS UNKNOWN WHICH MEDICATION THEY WERE TREATED WITH. THE PATIENT REMAINS IN THE HOSPITAL. THE EXPLANTED DEVICES WERE DISPOSED AT THE HOSPITAL AND WERE NOT RETURNED TO BSC.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
476512 VERCISE GENUS? STIMULATOR, ELECTRICAL, IMPLANTED, FOR PARKINSONIAN TREMOR MHY BOSTON SCIENTIFIC NEUROMODULATION CORPORATION DB-1216 763118 08714729985044

Patients

Seq Age Sex Outcome Treatment
1