FDA Adverse Event Malfunction Summary report: N

INGENIO

MDR report key: 21012245 · Received December 24, 2024

Report

Report Number
2124215-2024-81752
Event Type
Malfunction
Date Received
December 24, 2024
Date of Event
December 17, 2024
Report Date
January 21, 2025
Manufacturer
BOSTON SCIENTIFIC CORPORATION
Product Code
LWW
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
JA
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

THIS PRODUCT HAS NOT BEEN RETURNED TO BOSTON SCIENTIFIC, AND AS A RESULT, LABORATORY ANALYSIS COULD NOT BE CONDUCTED. THE ASSOCIATED INVESTIGATION DETERMINED THAT THIS DEVICE EXHIBITED INTERMITTENT FLUCTUATIONS IN IMPEDANCE MEASUREMENTS WITH NO CONCLUSIVE EVIDENCE OF A PRODUCT PERFORMANCE ISSUE; PLEASE REFER TO THE DESCRIPTION FOR MORE INFORMATION REGARDING THE SPECIFIC CIRCUMSTANCES OF THIS EVENT.

Description of Event or Problem · 0

IT WAS REPORTED THAT THIS PACEMAKER SYSTEM TRIGGERED A LEAD SAFETY SWITCH (LSS) ALERT DUE TO HIGH OUT-OF-RANGE RIGHT VENTRICULAR (RV) LEAD IMPEDANCES, MEASURING BETWEEN 1600 AND 2000 OHMS. CONTINUED MONITORING AND FOLLOW-UP WERE PLANNED, AS LEAD FAILURE WAS SUSPECTED. THE RV LEAD IS A NON-BOSTON SCIENTIFIC DEVICE. NO ADVERSE PATIENT EFFECTS WERE REPORTED. THIS PACEMAKER REMAINS IN SERVICE.

Description of Event or Problem · 0

IT WAS REPORTED THAT THIS PACEMAKER SYSTEM TRIGGERED A LEAD SAFETY SWITCH (LSS) ALERT DUE TO HIGH OUT-OF-RANGE RIGHT VENTRICULAR (RV) LEAD IMPEDANCES, MEASURING BETWEEN 1600 AND 2000 OHMS. CONTINUED MONITORING AND FOLLOW-UP WERE PLANNED, AS LEAD FAILURE WAS SUSPECTED. THE RV LEAD IS A NON-BOSTON SCIENTIFIC DEVICE. NO ADVERSE PATIENT EFFECTS WERE REPORTED. THIS PACEMAKER REMAINS IN SERVICE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2496070 INGENIO PACEMAKER LWW BOSTON SCIENTIFIC CORPORATION J172 294782

Patients

Seq Age Sex Outcome Treatment
1 17 YR Female