{ "meta": { "disclaimer": "Do not rely on openFDA to make decisions regarding medical care. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. We may limit or otherwise restrict your access to the API in line with our Terms of Service.", "terms": "https://open.fda.gov/terms/", "license": "https://open.fda.gov/license/", "last_updated": "2026-09-08", "results": { "skip": 0, "limit": 1, "total": 1 } }, "results": [ { "manufacturer_contact_zip_ext": "", "manufacturer_g1_address_2": "", "event_location": "HOSPITAL", "report_to_fda": "", "manufacturer_contact_t_name": "", "manufacturer_contact_state": "", "manufacturer_link_flag": "Y", "manufacturer_contact_address_2": "", "manufacturer_g1_city": "", "manufacturer_contact_address_1": "", "manufacturer_contact_pcity": "", "event_type": "Death", "report_number": "2955842-2013-03652", "type_of_report": [ "Initial submission" ], "product_problem_flag": "N", "date_received": "20130918", "manufacturer_address_2": "", "pma_pmn_number": "K081137", "date_of_event": "20130812", "reprocessed_and_reused_flag": "N", "manufacturer_address_1": "", "exemption_number": "", "manufacturer_contact_zip_code": "", "reporter_occupation_code": "OTHER", "manufacturer_contact_plocal": "", "noe_summarized": "1", "manufacturer_contact_l_name": "", "source_type": [ "Health Professional", "User facility", "Company representation" ], "distributor_zip_code_ext": "", "manufacturer_g1_postal_code": "", "manufacturer_g1_state": "", "reporter_country_code": "", "manufacturer_contact_area_code": "", "date_added": "20130919", "manufacturer_contact_f_name": "", "previous_use_code": "", "device": [ { "device_event_key": "", "implant_flag": "", "date_removed_flag": "", "device_sequence_number": "469361", "implant_date_year": "", "date_removed_year": "", "serviced_by_3rd_party_flag": "", "date_received": "20130918", "brand_name": "DA VINCI SI SURGICAL SYSTEM", "generic_name": "ENDOSCOPIC INSTRUMENT CONTROL SYSTEM", "manufacturer_d_name": "INTUITIVE SURGICAL,INC.", "manufacturer_d_address_1": "", "manufacturer_d_address_2": "", "manufacturer_d_city": "SUNNYVALE", "manufacturer_d_state": "CA", "manufacturer_d_zip_code": "", "manufacturer_d_zip_code_ext": "", "manufacturer_d_country": "", "manufacturer_d_postal_code": "", "device_operator": "HEALTH PROFESSIONAL", "model_number": "IS3000 A6.0P8", "catalog_number": "", "lot_number": "", "other_id_number": "", "device_availability": "No", "device_report_product_code": "NAY", "device_age_text": "", "device_evaluated_by_manufacturer": "", "combination_product_flag": "N", "udi_di": "", "udi_public": "", "openfda": { "device_name": "System, Surgical, Computer Controlled Instrument", "medical_specialty_description": "Gastroenterology, Urology", "regulation_number": "876.1500", "device_class": "2" } } ], "product_problems": [ "Adverse Event Without Identified Device or Use Problem" ], "reporter_state_code": "UT", "manufacturer_zip_code": "", "suppl_dates_mfr_received": "", "mfr_report_type": "Thirty-Day", "manufacturer_contact_country": "", "date_changed": "20250825", "health_professional": "", "summary_report_flag": "N", "manufacturer_g1_zip_code_ext": "", "manufacturer_contact_extension": "", "manufacturer_city": "", "manufacturer_contact_phone_number": "", "patient": [ { "patient_sequence_number": "1", "date_received": "20130918", "sequence_number_treatment": [ "DA VINCI SI SURGICAL SYS, INSTMNTS, ACCESS & ESU" ], "sequence_number_outcome": [ "" ], "patient_age": "66 YR", "patient_sex": "", "patient_weight": "85", "patient_ethnicity": "", "patient_race": "", "patient_problems": [ "Failure to Anastomose", "Death" ] } ], "distributor_city": "", "date_report": "20130819", "initial_report_to_fda": "", "distributor_state": "", "event_key": "", "manufacturer_g1_country": "", "manufacturer_contact_city": "", "mdr_report_key": "3355956", "removal_correction_number": "", "number_devices_in_event": "", "date_manufacturer_received": "20130819", "manufacturer_name": "", "report_source_code": "Manufacturer report", "remedial_action": [ "" ], "manufacturer_g1_zip_code": "", "report_to_manufacturer": "", "manufacturer_zip_code_ext": "", "manufacturer_g1_name": "", "adverse_event_flag": "Y", "distributor_address_1": "", "manufacturer_state": "", "distributor_address_2": "", "manufacturer_postal_code": "", "single_use_flag": "", "manufacturer_country": "", "mdr_text": [ { "mdr_text_key": "3746553", "text_type_code": "Description of Event or Problem", "patient_sequence_number": "1", "text": "IT WAS REPORTED THAT 30 HOURS POST-OP A DA VINCI SI ROUX-EN-Y PROCEDURE ON (B)(6) 2013, DURING AN EXPLORATORY PROCEDURE, IT WAS DISCOVERED THAT THE PATIENT HAD AN ANASTOMOTIC LEAK. THE LEAK CAUSED THE PATIENT'S ORGANS TO BECOME ACIDIC AND RESULTED IN THE PATIENT'S DEMISE ON (B)(6) 2013. ON (B)(4) 2013, INTUITIVE SURGICAL, INC. (ISI) CONTACTED THE SURGEON WHO PERFORMED THE SURGICAL PROCEDURE. ACCORDING TO THE SURGEON, THE PATIENT BEGAN TO PRESENT COMPLICATIONS 1 DAY POST-OP. THE PATIENT UNDERWENT AN EXPLORATORY SURGICAL PROCEDURE AND IT WAS DISCOVERED THAT THE PATIENT HAD AN ANASTOMOTIC LEAK. THE AFFECTED AREA WAS REPAIRED. THE SURGEON INDICATED THAT NO MALFUNCTION OF THE DA VINCI SI SURGICAL SYSTEM, INSTRUMENTS OR ACCESSORIES OCCURRED DURING THE (B)(6) 2013 SURGICAL PROCEDURE AND THAT INTRA-OPERATIVELY THE PATIENT DID NOT EXPERIENCE ANY COMPLICATIONS. THE SURGEON STATED THAT THE SURGICAL PROCEDURE WAS SUCCESSFULLY COMPLETED AND THE ANASTOMOTIC LEAK AND SUBSEQUENT DEMISE OF THE PATIENT WERE UNRELATED TO THE DA VINCI SI SURGICAL SYSTEM, INSTRUMENTS AND ACCESSORIES. HE STATED THAT THE COMPLICATIONS EXPERIENCED BY THE PATIENT WERE THE RESULT OF THE ANASTOMOTIC LEAK. ON (B)(4) 2013, ISI CONTACTED THE SITE'S RISK MANAGER REGARDING THE REPORTED EVENT. THE RISK MANAGER INDICATED THAT NO AUTOPSY WAS PERFORMED, AS THE PATIENT'S FAMILY DECLINED TO HAVE ONE PERFORMED. THE RISK MANAGER INDICATED THAT AT THIS TIME THE HOSPITAL'S INTERNAL INVESTIGATION REGARDING THE REPORTED EVENT HAS NOT BEEN PERFORMED." }, { "mdr_text_key": "11285909", "text_type_code": "Additional Manufacturer Narrative", "patient_sequence_number": "1", "text": "BASED ON THE INFORMATION PROVIDED, INTUITIVE SURGICAL, INC. (ISI) HAS DETERMINED THAT THE PATIENT'S DEMISE WAS UNRELATED TO A MALFUNCTION OF THE DA VINCI SI SURGICAL SYSTEM, INSTRUMENTS OR ACCESSORIES, BUT RATHER DUE TO THE PATIENT'S POST-OPERATIVE ANASTOMOTIC LEAK. THIS COMPLAINT IS BEING REPORTED DUE TO THE FOLLOWING CONCLUSION: THE PATIENT EXPIRED POST-OP A DA VINCI SI ROUX-EN-Y PROCEDURE. REVIEW OF THE SITE'S SYSTEM LOGS FOR THE REPORTED PROCEDURE DATE FOUND THAT NO SYSTEM ERRORS WERE GENERATED THAT WOULD HAVE CAUSED OR CONTRIBUTED TO THE INJURY SUSTAINED BY THE PATIENT." } ], "number_patients_in_event": "", "distributor_name": "", "manufacturer_g1_address_1": "", "distributor_zip_code": "", "manufacturer_contact_postal_code": "", "manufacturer_contact_exchange": "", "manufacturer_contact_pcountry": "", "suppl_dates_fda_received": "" } ] }