MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative report with the FDA on 2020-03-30 for DYNAGEN EL ICD DR D153 manufactured by Boston Scientific Corporation.
[185776320]
This product has not been returned to boston scientific, and as a result, laboratory analysis could not be conducted. Investigation of the available information determined this device exhibited oversensing of noise generated by the minute ventilation (mv)/respiratory sensor that is related to a high impedance condition. Please see the description for more information regarding the specific circumstances of this event.
Patient Sequence No: 1, Text Type: N, H10
[185776321]
It was reported that this implantable cardioverter defibrillator (icd) and a non boston scientific right atrial (ra) lead exhibited noise, oversensing, and inappropriate atrial tachy response (atr) episodes. The noise appeared to be oversensing of minute ventilation (mv)/respiratory sensor signals. Programming options were discussed. No adverse patient effects were reported. The device remains in service.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2124215-2020-04358 |
| MDR Report Key | 9901577 |
| Report Source | COMPANY REPRESENTATIVE |
| Date Received | 2020-03-30 |
| Date of Report | 2020-03-30 |
| Date of Event | 2019-11-20 |
| Date Mfgr Received | 2020-02-24 |
| Device Manufacturer Date | 2018-11-21 |
| Date Added to Maude | 2020-03-30 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | TIMOTHY DEGROOT |
| Manufacturer Street | 4100 HAMLINE AVENUE NORTH |
| Manufacturer City | SAINT PAUL MN 55112 |
| Manufacturer Country | US |
| Manufacturer Postal | 55112 |
| Manufacturer Phone | 6515826168 |
| Manufacturer G1 | BOSTON SCIENTIFIC CORPORATION |
| Manufacturer Street | CASHEL ROAD |
| Manufacturer City | CLONMEL |
| Manufacturer Country | EI |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | DYNAGEN EL ICD DR |
| Generic Name | IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (NON-CRT) |
| Product Code | LWS |
| Date Received | 2020-03-30 |
| Model Number | D153 |
| Catalog Number | D153 |
| Lot Number | 214969 |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BOSTON SCIENTIFIC CORPORATION |
| Manufacturer Address | 4100 HAMLINE AVENUE NORTH SAINT PAUL MN 55112 US 55112 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-03-30 |