| Brand Name | Vercise Genus? |
| 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 |
| cashel road |
|
| clonmel E91 T 862 |
|
EI
E91 T862
|
|
| Manufacturer Contact |
|
ricardo
amaro castro
|
| 25155 rye canyon loop |
| valencia, CA 91355
|
|
+1(320)800-7570
|
|
| MDR Report Key | 50225892 |
| Report Number | 3006630150-2026-05831 |
| Device Sequence Number | 10296957 |
| Product Code |
MHY
|
| UDI-Device Identifier | 08714729985044 |
| UDI-Public | (01)08714729985044(17)240329(10)537681 |
| Combination Product (Y/N) | N |
| Initial Reporter State | MA |
| Initial Reporter Country | US |
| PMA/510(K) Number | P150031 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2022 |
| Reporter Type |
Manufacturer
|
| Report Source |
Other,Foreign,Health Professional,Company Representative |
| Remedial Action |
Notification |
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
09/22/2026 |
| 1 Device was Involved in the Event |
|
| 1 Patient was Involved in the Event |
|
| Is this an Adverse Event Report? |
No
|
| Is this a Product Problem Report? |
Yes
|
| Operator of Device |
Lay User/Patient
|
| Device Expiration Date | 03/29/2024 |
| Device Model Number | DB-1216 |
| Device Catalogue Number | DB-1216 |
| Device Lot Number | 537681 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 07/22/2026 |
| Supplement Date Received by Manufacturer | 09/02/2026
|
| Initial Report FDA Received Date | 08/12/2026 |
| Supplement Report FDA Received Date | 09/22/2026
|
| Date Device Manufactured | 03/30/2022 |
| 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 | 33 YR |
| Patient Sex | Male |
|
|