The fourth patient died from progressive shock with renal and hepatic failure following cardiac arrest 23 days after admission; bleeding remained uncontrolled despite treatment with 4-factor prothrombin complex concentrate, recombinant FVIII (rFVIII), and rFVIIa, and a pulmonary embolism eventually developed after two days of rFVIIa therapy (30 μg/kg), prompting a switch to plasma exchange [32]. This evidence concerns the gene F8 and pulmonary embolism.