MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION INOGEN EL ICD DR; IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (NON-CRT)

Model Number	D143
Medical Device Problem Codes	Signal Artifact/Noise (1036); Failure to Capture (1081); Over-Sensing (1438); Pacing Problem (1439)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	08/13/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
If pertinent information is provided in the future, a supplemental report will be submitted.
Event or Problem Description
It was reported that this implantable cardioverter defibrillator (icd), implanted with a non-boston scientific right ventricular (rv) lead, exhibited a sudden rise in pace impedances from the 500-ohms range to out-of-range pace impedance measurements greater than 3,000 ohms.Shock impedance measurements were stable in the 40-50 ohms range.Prior to and since then, there were numerous false episodes of no therapy and 1 burst of anti-tachycardia pacing (atp) due to oversensed noise.The atp did not appear to have capture.It was noted that the patient was not pacer dependent an underlying rhythm was observed.Technical services (ts) discussed troubleshooting options including pocket manipulations, isometrics, and possible x-rays.Additional information received reported that the rv lead was surgically abandoned and replaced.It was noted that the icd was explanted and upgraded to a device with an updated header.No adverse patient effects were reported.
Additional Manufacturer Narrative
The returned device was thoroughly inspected and analyzed upon receipt at our post market quality assurance laboratory.Visual examination of the device header and case noted no anomalies.Dimensional analysis of the header was completed.Each port measured as expected.The device was then exposed to simulated heart load conditions, and the defibrillation, pacing, and sensing functions were tested.Impedance testing was completed and all measurements were within normal limits.The device operated appropriately with no interruptions in therapy output at the returned programmed settings.A series of electrical tests was also performed, and again, normal device function was observed.Analysis did not identify any device characteristics that would have caused or contributed to the reported clinical observations.
Event or Problem Description
It was reported that this implantable cardioverter defibrillator (icd), implanted with a non boston scientific right ventricular (rv) lead, exhibited a sudden rise in pace impedances from the 500-ohms range to out-of-range pace impedance measurements greater than 3,000 ohms.Shock impedance measurements were stable in the 40-50 ohms range.Prior to and since then, there were numerous false episodes of no therapy and 1 burst of anti-tachycardia pacing (atp) due to oversensed noise.The atp did not appear to have capture.It was noted that the patient was not pacer dependent an underlying rhythm was observed.Technical services (ts) discussed troubleshooting options including pocket manipulations, isometrics, and possible x-rays.Additional information received reported that the rv lead was surgically abandoned and replaced.It was noted that the icd was explanted and upgraded to a device with an updated header.No adverse patient effects were reported.

• Brand Name: INOGEN EL ICD DR
• Common Device Name: IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (NON-CRT)
• 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: 23027833
• Report Number: 2124215-2025-63944
• Device Sequence Number: 9681784
• Product Code: LWS
• UDI-Device Identifier: 00802526534263
• UDI-Public: (01)00802526534263(17)200103
• Combination Product (Y/N): N
• Initial Reporter State: IN
• Initial Reporter Country: US
• PMA/510(K) Number: P960040
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2019
• Device Explanted Year: 2025
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 01/14/2026

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Lay User/Patient
• Device Expiration Date: 01/03/2020
• Device Model Number: D143
• Device Catalogue Number: D143
• Device Lot Number: 211401
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/18/2025
• Supplement Date Received by Manufacturer: 12/31/2025
• Initial Report FDA Received Date: 09/11/2025
• Supplement Report FDA Received Date: 01/14/2026
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 01/18/2018
• 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
• Patient Age: 61 YR
• Patient Sex: Female