FDA Adverse Event Injury Summary report: N

VERCISE GENUS

MDR report key: 21023350 · Received December 26, 2024

Report

Report Number
3006630150-2024-09027
Event Type
Injury
Date Received
December 26, 2024
Date of Event
September 28, 2024
Report Date
December 26, 2024
Manufacturer
BOSTON SCIENTIFIC NEUROMODULATION CORPORATION
Product Code
MHY
UDI-DI
08714729985044
PMA / PMN Number
P150031
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
PA, US
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

ADDITIONAL SUSPECT MEDICAL DEVICE COMPONENT INVOLVED IN THE EVENT: PRODUCT FAMILY: DBS-LINEAR LEADS, UPN: M365DB2202300, MODEL: DB-2202-30, SERIAL: (B)(6), BATCH: 7072239. PRODUCT FAMILY: DBS-LINEAR LEADS, UPN: M365DB2202300, MODEL: DB-2202-30, SERIAL: (B)(6), BATCH: 7082277. PRODUCT FAMILY: DBS-LINEAR LEADS, UPN: M365DB2202450, MODEL: DB-2202-45, SERIAL: (B)(6), BATCH: 7116515. PRODUCT FAMILY: DBS-EXTENSION, UPN: M365NM3138550, MODEL: NM-3138-55, SERIAL: (B)(6), BATCH: 7115376. PRODUCT FAMILY: DBS-EXTENSION, UPN: M365NM3138550, MODEL: NM-3138-55, SERIAL: (B)(6), BATCH: 7115079.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE DEEP BRAIN STIMULATION (DBS) PATIENT EXPERIENCED REDNESS AND SWELLING OVER THEIR IMPLANTABLE PULSE GENERATOR (IPG) POCKET IN THEIR CHEST. THE PHYSICIAN ASSESSED THAT THE PATIENT HAD DEVELOPED AN INFECTION. IT WAS UNKNOWN IF A CULTURE WAS TAKEN. THE PATIENT WAS ADMINISTERED ANTIBIOTICS, UNDERWENT A FULL SYSTEM EXPLANT PROCEDURE, WAS ADMITTED TO THE HOSPITAL, AND WAS DOING WELL POSTOPERATIVELY. THE DEVICES WERE RETAINED BY THE FACILITY AND NOT RETURNED TO BE ANALYZED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2281365 VERCISE GENUS STIMULATOR, ELECTRICAL, IMPLANTED, FOR PARKINSONIAN TREMOR MHY BOSTON SCIENTIFIC NEUROMODULATION CORPORATION DB-1216 593504 08714729985044

Patients

Seq Age Sex Outcome Treatment
1 74 YR Male Required Intervention