MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2020-01-23 for VERCISE GEVIA DB-1200-S manufactured by Boston Scientific Neuromodulation.
[176204073]
Date of death is december 2019, the exact date is unknown.
Patient Sequence No: 1, Text Type: N, H10
[176204074]
A report was received that the patient passed away one week after being implanted with the deep brain stimulation system. The physician stated that the patients death was due to a pulmonary embolism and not due to the device or to cranial artery. The exact date of death is unknown.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3006630150-2020-00165 |
| MDR Report Key | 9624801 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2020-01-23 |
| Date of Report | 2020-01-23 |
| Date of Event | 2019-12-27 |
| Date Mfgr Received | 2020-01-03 |
| Device Manufacturer Date | 2019-10-08 |
| Date Added to Maude | 2020-01-23 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 0 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | TALAR TAHMASIAN |
| Manufacturer Street | 25155 RYE CANYON LOOP |
| Manufacturer City | VALENCIA CA 91355 |
| Manufacturer Country | US |
| Manufacturer Postal | 91355 |
| Manufacturer Phone | 6619494863 |
| Manufacturer G1 | BOSTON SCIENTIFIC CORPORATION |
| Manufacturer Street | CASHEL ROAD |
| Manufacturer City | CLONMEL |
| Manufacturer Country | EI |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | VERCISE GEVIA |
| Generic Name | STIMULATOR, ELECTRICAL, IMPLANTED, FOR PARKINSONIAN SYMPTOMS |
| Product Code | NHL |
| Date Received | 2020-01-23 |
| Model Number | DB-1200-S |
| Catalog Number | DB-1200-S |
| Lot Number | 740027 |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BOSTON SCIENTIFIC NEUROMODULATION |
| Manufacturer Address | 25155 RYE CANYON LOOP VALENCIA CA 91355 US 91355 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Death | 2020-01-23 |