FDA Adverse Event Injury Summary report: N

TELIGEN

MDR report key: 13502455 · Received February 9, 2022

Report

Report Number
2124215-2022-04184
Event Type
Injury
Date Received
February 9, 2022
Date of Event
December 6, 2021
Report Date
May 21, 2022
Manufacturer
BOSTON SCIENTIFIC CORPORATION
Product Code
LWP
PMA / PMN Number
P960040/S155
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MA, US
Reporter Occupation
003

Narratives

Additional Manufacturer Narrative · 0

THE RETURNED DEVICE WAS THOROUGHLY INSPECTED AND ANALYZED UPON RECEIPT AT OUR POST MARKET QUALITY ASSURANCE LABORATORY. VISUAL EXAMINATION OF THE DEVICE HEADER AND CASE NOTED NO ANOMALIES. PIN GAGE TESTING, DESIGNED TO VERIFY PROPER PORT DIMENSIONS, WAS COMPLETED. EACH PORT MEASURED AS EXPECTED. THE DEVICE WAS THEN EXPOSED TO SIMULATED HEART LOAD CONDITIONS, AND THE PACING, AND SENSING FUNCTIONS WERE TESTED. IMPEDANCE TESTING WAS COMPLETED AND ALL MEASUREMENTS WERE WITHIN NORMAL LIMITS. THE DEVICE OPERATED APPROPRIATELY WITH NO INTERRUPTIONS IN THERAPY OUTPUT AT THE RETURNED PROGRAMMED SETTINGS. A SERIES OF ELECTRICAL TESTS WAS ALSO PERFORMED, AND AGAIN, NORMAL DEVICE FUNCTION WAS OBSERVED. ANALYSIS DID NOT IDENTIFY ANY DEVICE CHARACTERISTICS THAT WOULD HAVE CAUSED OR CONTRIBUTED TO THE REPORTED CLINICAL OBSERVATIONS.

Additional Manufacturer Narrative · 0

AS NO FURTHER INFORMATION CONCERNING THIS REPORT IS EXPECTED, OUR INVESTIGATION IS COMPLETE. THIS INVESTIGATION WILL BE UPDATED SHOULD FURTHER INFORMATION BE PROVIDED.

Additional Manufacturer Narrative · 0

AS NO FURTHER INFORMATION CONCERNING THIS REPORT IS EXPECTED, OUR INVESTIGATION IS COMPLETE. THIS INVESTIGATION WILL BE UPDATED SHOULD FURTHER INFORMATION BE PROVIDED.

Description of Event or Problem · 0

IT WAS REPORTED THAT THIS DEVICE WAS EMITTING TONES AND ELECTIVE REPLACEMENT INDICATOR (ERI) WAS TRIGGERED. ADDITIONALLY, AN EPISODE OF NOISE AND OVERSENSING WAS IDENTIFIED. THE CALLER WAS INQUIRING ABOUT DEVICE LONGEVITY AS IT WAS OBSERVED TO BE TEN MONTHS TWO DAYS PRIOR AFTER INCREASING THE RIGHT VENTRICULAR (RV) OUTPUT. THE CALLER STATED THERE WAS NO RV PACING AND INQUIRED HOW THE DEVICE COULD REACH ERI IF THERE WAS NO PACING THERAPY. A BOSTON SCIENTIFIC TECHNICAL SERVICES CONSULTANT DOCUMENTED AND DISCUSSED THE REPORTED CLINICAL OBSERVATIONS. NO ADVERSE PATIENT EFFECTS WERE REPORTED. IT WAS REPORTED THAT THIS DEVICE WAS SUBSEQUENTLY EXPLANTED AND REPLACED. NO ADDITIONAL ADVERSE PATIENT EFFECTS WERE REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT THIS DEVICE WAS EMITTING TONES AND ELECTIVE REPLACEMENT INDICATOR (ERI) WAS TRIGGERED. ADDITIONALLY, AN EPISODE OF NOISE AND OVERSENSING WAS IDENTIFIED. THE CALLER WAS INQUIRING ABOUT DEVICE LONGEVITY AS IT WAS OBSERVED TO BE TEN MONTHS TWO DAYS PRIOR AFTER INCREASING THE RIGHT VENTRICULAR (RV) OUTPUT. THE CALLER STATED THERE WAS NO RV PACING AND INQUIRED HOW THE DEVICE COULD REACH ERI IF THERE WAS NO PACING THERAPY. A BOSTON SCIENTIFIC TECHNICAL SERVICES CONSULTANT DOCUMENTED AND DISCUSSED THE REPORTED CLINICAL OBSERVATIONS. NO ADVERSE PATIENT EFFECTS WERE REPORTED. IT WAS REPORTED THAT THIS DEVICE WAS SUBSEQUENTLY EXPLANTED AND REPLACED. NO ADDITIONAL ADVERSE PATIENT EFFECTS WERE REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT THIS DEVICE WAS EMITTING TONES AND ELECTIVE REPLACEMENT INDICATOR (ERI) WAS TRIGGERED. ADDITIONALLY, AN EPISODE OF NOISE AND OVERSENSING WAS IDENTIFIED. THE CALLER WAS INQUIRING ABOUT DEVICE LONGEVITY AS IT WAS OBSERVED TO BE TEN MONTHS TWO DAYS PRIOR AFTER INCREASING THE RIGHT VENTRICULAR (RV) OUTPUT. THE CALLER STATED THERE WAS NO RV PACING AND INQUIRED HOW THE DEVICE COULD REACH ERI IF THERE WAS NO PACING THERAPY. A BOSTON SCIENTIFIC TECHNICAL SERVICES CONSULTANT DOCUMENTED AND DISCUSSED THE REPORTED CLINICAL OBSERVATIONS. NO ADVERSE PATIENT EFFECTS WERE REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
895596 TELIGEN IMPLANTABLE PULSE GENERATOR, PACEMAKER (NON-CRT) LWP BOSTON SCIENTIFIC CORPORATION E102 243923

Patients

Seq Age Sex Outcome Treatment
1 43 YR Male Required Intervention| H