MAUDE Adverse Event Report: BOSTON SCIENTIFIC NEUROMODULATION CORPORATION; STIMULATOR, ELECTRICAL, IMPLANTED, FOR PARKINSONIAN TREMOR

Model Number	DB-3128-55B
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Wound Dehiscence (1154); Purulent Discharge (1812); Unspecified Infection (1930); Impaired Healing (2378)
Date of Event	02/15/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Block d2b: additional pro codes, nhl, pjs.Block b3: exact date unknown, event occurred between after date of initial implant and (b)(6) 2025.Additional suspect medical device components involved in the event: product family: bs-linear leads, upn: m365db2202450, model: db-2202-45, serial: (b)(6), batch: 7129254, udi: (b)(4).Product family: bs-linear leads, upn: m365db2202450, model: db-2202-45, serial: (b)(6), batch: 7131984, udi: (b)(4).Product family: dbs-ipg-r-mri, upn: m365db12160, model: db-1216, serial: (b)(6), batch: 774963, udi: (b)(4).Product family: dbs-lead fixation, upn: m365db4600c0, model: db-4600-c, serial: n/a, batch: 35357580, udi: (b)(4).Product family: dbs-lead fixation, upn: m365db4600c0 model: db-4600-c, serial: n/a, batch: 35448611, udi: (b)(4).
Event or Problem Description
It was reported that the deep brain stimulation (dbs) patient experienced dehiscence and purulent discharge at the lead extension implant site.Cultures were taken however the results are not available.The patient underwent a procedure wherein the dbs system was completely removed.The physician assessed that the patient has a history of poor wound healing that may have contributed.Physical analysis of the dbs devices was not performed as they were retained by the facility.The patient did well post-operatively.

• Brand Name: NA
• Common Device Name: STIMULATOR, ELECTRICAL, IMPLANTED, FOR PARKINSONIAN TREMOR
• Manufacturer (Section D): BOSTON SCIENTIFIC NEUROMODULATION CORPORATION; 25155 rye canyon loop; valencia CA 91355
• Manufacturer (Section G): BOSTON SCIENTIFIC CORPORATION; road 698, lot no. 12; dorado PR 00646 -260; * 00646-2602
• Manufacturer Contact: erik sherburne ; 25155 rye canyon loop; valencia, CA 91355 ; 7632920920
• MDR Report Key: 22171969
• Report Number: 2124215-2025-37808
• Device Sequence Number: 9199931
• Product Code: MHY
• UDI-Device Identifier: 00191506023577
• UDI-Public: (01)00191506023577(17)260508(10)5002958
• Combination Product (Y/N): N
• Initial Reporter State: NC
• Initial Reporter Country: US
• PMA/510(K) Number: P150031
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2025
• Device Explanted Year: 2025
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 06/09/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Lay User/Patient
• Device Expiration Date: 05/08/2026
• Device Model Number: DB-3128-55B
• Device Catalogue Number: DB-3128-55B
• Device Lot Number: 5002958
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/15/2025
• Initial Report FDA Received Date: 06/09/2025
• Date Device Manufactured: 05/08/2024
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Age: 61 YR
• Patient Sex: Male