MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION DYNAGEN MINI ICD VR; Implantable Cardioverter Defibrillator

Model Number	D020
Medical Device Problem Code	Premature Discharge of Battery (1057)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/03/2025
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that this device recorded a code 1003 indicative of battery voltage too low for the projected remaining capacity.A request was made to have data from this device analyzed.Data analysis confirmed low voltage fault.The device hardware was not detecting the loss of battery energy and with this the battery status indicators were not reflecting the depletion and is inaccurate.The device is malfunctioning, and device replacement is recommended.To date, this device remains in service.No adverse patient effects were reported.
Event or Problem Description
It was reported that this device recorded a code 1003 indicative of battery voltage too low for the projected remaining capacity.A request was made to have data from this device analyzed.Data analysis confirmed low voltage fault.The device hardware was not detecting the loss of battery energy and with this the battery status indicators were not reflecting the depletion and is inaccurate.The device is malfunctioning, and device replacement is recommended.To date, this device remains in service.No adverse patient effects were reported.Additional information is received indicating that this device was explanted.No additional adverse patient effects were reported.
Event or Problem Description
It was reported that this device recorded a code 1003 indicative of battery voltage too low for the projected remaining capacity.A request was made to have data from this device analyzed.Data analysis confirmed low voltage fault.The device hardware was not detecting the loss of battery energy and with this the battery status indicators were not reflecting the depletion and is inaccurate.The device is malfunctioning, and device replacement is recommended.To date, this device remains in service.No adverse patient effects were reported.Additional information is received indicating that this device was explanted.No additional adverse patient effects were reported.
Additional Manufacturer Narrative
Revision to the initial mdr in block d6b explant date.This supplemental report was created to capture correction.

• Brand Name: DYNAGEN MINI ICD VR
• Common Device Name: Implantable Cardioverter Defibrillator
• 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: mark mischke ; 4100 hamline avenue north; saint paul, MN 55112 ; +1(612)875-7234
• MDR Report Key: 21965808
• Report Number: 2124215-2025-28876
• Device Sequence Number: 15484638
• Product Code: LWS
• UDI-Device Identifier: 00802526533860
• UDI-Public: (01)00802526533860(17)210729
• Combination Product (Y/N): N
• Initial Reporter State: MA
• Initial Reporter Country: US
• PMA/510(K) Number: P960040
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2020
• Device Explanted Year: 2026
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup,Followup,Followup
• Report Date (Section B): 09/29/2026

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Operator of Device: Lay User/Patient
• Device Expiration Date: 07/29/2021
• Device Model Number: D020
• Device Catalogue Number: D020
• Device Lot Number: 222673
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 01/27/2026
• Is the Reporter a Health Professional?: No
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/08/2025
• Supplement Date Received by Manufacturer: 01/26/2026; 02/26/2026; 09/14/2026
• Initial Report FDA Received Date: 05/06/2025
• Supplement Report FDA Received Date: 02/13/2026; 03/12/2026; 09/29/2026
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 08/12/2019
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention; Hospitalization
• Patient Age: 61 YR
• Patient Sex: Female