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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION INGEVITY MRI; IMPLANTABLE LEAD

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BOSTON SCIENTIFIC CORPORATION INGEVITY MRI; IMPLANTABLE LEAD Back to Search Results
Model Number 7732
Medical Device Problem Code Fracture (1260)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 01/06/2026
Type of Reportable Event Malfunction
Event or Problem Description
It was reported that the right ventricular (rv) lead exhibited lead fractured.Boston scientific technical services (ts) stated that the system is no longer magnetic resonance imaging (mri) conditional.This lead remains in service.No adverse patient effects were reported.
 
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Brand Name
INGEVITY MRI
Common Device Name
IMPLANTABLE LEAD
Manufacturer (Section D)
BOSTON SCIENTIFIC CORPORATION
4100 hamline avenue north
saint paul MN 55112
Manufacturer (Section G)
BOSTON SCIENTIFIC CORPORATION
road 698, lot no. 12
dorado PR 00646 -260
*   00646-2602
Manufacturer Contact
timothy degroot
4100 hamline avenue north
saint paul, MN 55112
6515826168
MDR Report Key24194530
Report Number2124215-2026-04862
Device Sequence Number18175568
Product Code NVN
UDI-Device Identifier00802526523335
UDI-Public(01)00802526523335(17)211009
Combination Product (Y/N)Y
Initial Reporter StateCA
Initial Reporter CountryUS
PMA/510(K) Number
P150012
Number of Events Summarized1
Summary Report (Y/N)N
Device Implanted Year2019
Serviced by Third Party (Y/N)Unknown
Reporter Type Manufacturer
Report Source Company Representative
Initial Reporter Occupation Other Health Care Professional
Type of Report Initial,Followup
Report Date (Section B) 05/22/2026
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 Date10/09/2021
Device Model Number7732
Device Catalogue Number7732
Device Lot Number1013157
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 01/06/2026
Supplement Date Received by Manufacturer05/08/2026
Initial Report FDA Received Date01/27/2026
Supplement Report FDA Received Date05/22/2026
Date Device Manufactured10/09/2019
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 Number1
Patient Age88 YR
Patient SexFemale
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