MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION EASYTRAK 2 IS-1; IMPLANTABLE LEAD

Model Number 4543

Device Problems High impedance (1291); Defective Device (2588)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 01/23/2023

Event Type  Injury  

Event Description

It was reported that this left ventricular (lv) lead had high out of range pacing impedances.This patient was admitted to this hospital for further evaluation.The patient was noted to have had physical strain several months ago, and it is suspected that this physical effort caused lead damage.The lv pacing was subsequently disabled, and device reprogrammed to right ventricular (rv) lead only.No additional adverse patient effects were reported.

Event Description

It was reported that this left ventricular (lv) lead had high out of range pacing impedances.This patient was admitted to this hospital for further evaluation.The patient was noted to have had physical strain several months ago, and it is suspected that this physical effort caused lead damage.The lv pacing was subsequently disabled, and device reprogrammed to right ventricular (rv) lead only.No additional adverse patient effects were reported.

Manufacturer Narrative

This lead remains implanted and disabled, therefore return is not expected.

• Brand Name: EASYTRAK 2 IS-1
• Type of Device: IMPLANTABLE LEAD
• Manufacturer (Section D): BOSTON SCIENTIFIC CORPORATION; 4100 hamline avenue north; saint paul MN 55112
• Manufacturer (Section G): BOSTON SCIENTIFIC CORPORATION; cashel road; clonmel ; EI
• Manufacturer Contact: timothy degroot ; 4100 hamline avenue north; saint paul, MN 55112 ; 6515826168
• MDR Report Key: 16373551
• MDR Text Key: 309509932
• Report Number: 2124215-2023-06611
• Device Sequence Number: 1
• Product Code: NIK
• UDI-Device Identifier: 00802526410994
• UDI-Public: 00802526410994
• Combination Product (y/n): Y
• Reporter Country Code: IT
• PMA/PMN Number: P010012/S024
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Foreign,Company Representative
• Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date: 03/09/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 02/14/2023
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Lay User/Patient
• Device Expiration Date: 10/18/2009
• Device Model Number: 4543
• Device Catalogue Number: 4543
• Device Lot Number: 133642
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 02/16/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 10/18/2007
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Hospitalization