FDA Adverse Event Injury Summary report: N

ENDOTAK RELIANCE SG

MDR report key: 14570192 · Received June 1, 2022

Report

Report Number
2124215-2022-19040
Event Type
Injury
Date Received
June 1, 2022
Date of Event
April 21, 2022
Report Date
June 5, 2025
Manufacturer
BOSTON SCIENTIFIC CORPORATION
Product Code
NVY
PMA / PMN Number
P910073/S077
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MA, US
Reporter Occupation
003

Narratives

Additional Manufacturer Narrative · 0

THIS RIGHT VENTRICULAR (RV) LEAD REMAINS IMPLANTED, IN-SERVICE AND HAS NOT BEEN RETURNED. AS SUCH, PHYSICAL ANALYSIS HAS NOT BEEN CONDUCTED IN OUR LABORATORY. HOWEVER, THE PRIMARY REPORTED OBSERVATION IS ADDRESSED IN PRODUCT LABELING (I.E. INSTRUCTIONS FOR USE). ANALYSIS DETERMINED THAT THE HIGH, OUT-OF-RANGE SHOCK IMPEDANCE MEASUREMENTS ARE A KNOWN INHERENT RISK WITH USE OF THIS PRODUCT, BUT ROOT CAUSE DETERMINATION IS ONGOING. THIS PRODUCT WAS MANUFACTURED PRIOR TO IMPLEMENTATION OF THE UDI REGULATION AND AS A RESULT, THE COMPLETE UDI IS NOT AVAILABLE. APPLICABLE US PRODUCT DATA HAS BEEN INCLUDED IN THIS REPORT.

Description of Event or Problem · 0

IT WAS REPORTED THAT A RED ALERT WAS RECORDED DUE TO CLIMBING HIGH SHOCK IMPEDANCE MEASUREMENTS THAT REACHED 125 OHMS. TECHNICAL SERVICES DISCUSSED THAT A COMMANDED SHOCK SHOULD BE PERFORMED IF THE RANGE GO AS HIGH AS 135 - 145 OHMS. HOWEVER, BECAUSE THE PATIENT IS ELDERLY AND HAS NEVER REQUIRED TACHY THERAPY, INCLUDING ANTI-TACHYCARDIA PACING, IT WAS BELIEVED RELUCTANT TO BRING THE PATIENT FOR TESTING. FURTHER INFORMATION WAS RECEIVED CONFIRMING NO COMMANDED SHOCKS WERE PERFORMED AND THE PATIENT WILL CONTINUE TO BE MONITORED. THIS RV LEAD REMAINS IN SERVICE AND NO ADVERSE PATIENT EFFECTS WERE REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT A RED ALERT WAS RECORDED DUE TO CLIMBING HIGH SHOCK IMPEDANCE MEASUREMENTS THAT REACHED 125 OHMS. TECHNICAL SERVICES DISCUSSED THAT A COMMANDED SHOCK SHOULD BE PERFORMED IF THE RANGE GO AS HIGH AS 135 - 145 OHMS. HOWEVER, BECAUSE THE PATIENT IS ELDERLY AND HAS NEVER REQUIRED TACHY THERAPY, INCLUDING ANTI-TACHYCARDIA PACING, IT WAS BELIEVED RELUCTANT TO BRING THE PATIENT FOR TESTING. FURTHER INFORMATION WAS RECEIVED CONFIRMING NO COMMANDED SHOCKS WERE PERFORMED AND THE PATIENT WILL CONTINUE TO BE MONITORED. THIS RV LEAD REMAINS IN SERVICE AND NO ADVERSE PATIENT EFFECTS WERE REPORTED. ADDITIONAL INFORMATION WAS RECEIVED INDICATING A SYNC SHOCK WAS PERFORMED, AND THE IMPEDANCE WAS 146 OHMS. SUBSEQUENTLY, THE RIGHT VENTRICULAR (RV) LEAD WAS SURGICALLY ABANDONED AND AND REPLACED, AND THE DEVICE WAS EXPLANTED AND REPLACED, DUE TO A PRODUCT PERFORMANCE ISSUE. NO ADDITIONAL ADVERSE PATIENT EFFECTS WERE REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT A RED ALERT WAS RECORDED DUE TO CLIMBING HIGH SHOCK IMPEDANCE MEASUREMENTS THAT REACHED 125 OHMS. TECHNICAL SERVICES DISCUSSED THAT A COMMANDED SHOCK SHOULD BE PERFORMED IF THE RANGE GO AS HIGH AS 135 - 145 OHMS. HOWEVER, BECAUSE THE PATIENT IS ELDERLY AND HAS NEVER REQUIRED TACHY THERAPY, INCLUDING ANTI-TACHYCARDIA PACING, IT WAS BELIEVED RELUCTANT TO BRING THE PATIENT FOR TESTING. FURTHER INFORMATION WAS RECEIVED CONFIRMING NO COMMANDED SHOCKS WERE PERFORMED AND THE PATIENT WILL CONTINUE TO BE MONITORED. THIS RV LEAD REMAINS IN SERVICE AND NO ADVERSE PATIENT EFFECTS WERE REPORTED. ADDITIONAL INFORMATION WAS RECEIVED INDICATING A SYNC SHOCK WAS PERFORMED, AND THE IMPEDANCE WAS 146 OHMS. SUBSEQUENTLY, THE RIGHT VENTRICULAR (RV) LEAD WAS SURGICALLY ABANDONED AND REPLACED, AND THE DEVICE WAS EXPLANTED AND REPLACED, DUE TO A PRODUCT PERFORMANCE ISSUE. NO ADDITIONAL ADVERSE PATIENT EFFECTS WERE REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
599588 ENDOTAK RELIANCE SG IMPLANTABLE LEAD NVY BOSTON SCIENTIFIC CORPORATION 0293 112702

Patients

Seq Age Sex Outcome Treatment
1 92 YR Male Hospitalization| R