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 MINI ICD VR D020 manufactured by Boston Scientific Corporation.
[185746936]
It was reported that this implantable cardioverter defibrillator (icd) exhibited right ventricular (rv) noise, oversensing, possible pacing inhibition, decreased pacing and shock impedance measurements, inappropriate anti-tachycardia pacing (atp), and an inappropriate shock. It was noted that the noise appeared to be from an external source. Troubleshooting options were discussed. No adverse patient effects were reported. The device remains in service.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2124215-2020-01604 |
| MDR Report Key | 9901597 |
| Report Source | COMPANY REPRESENTATIVE |
| Date Received | 2020-03-30 |
| Date of Report | 2020-03-30 |
| Date of Event | 2018-03-27 |
| Date Mfgr Received | 2020-01-27 |
| Device Manufacturer Date | 2016-02-15 |
| 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 MINI ICD VR |
| Generic Name | IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (NON-CRT) |
| Product Code | LWS |
| Date Received | 2020-03-30 |
| Model Number | D020 |
| Catalog Number | D020 |
| Lot Number | 210319 |
| Device Expiration Date | 2018-02-05 |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Age | DA |
| 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 |