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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION ESSENTIO? DR; IMPLANTABLE PACEMAKER

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BOSTON SCIENTIFIC CORPORATION ESSENTIO? DR; IMPLANTABLE PACEMAKER Back to Search Results
Model Number L101
Medical Device Problem Code Premature Discharge of Battery (1057)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 06/18/2026
Type of Reportable Event Serious Injury
Event or Problem Description
It was reported that this device recorded a code 1003, indicating the voltage is too low for the projected remaining capacity.This device was subsequently explanted.Another device was implanted to complete the procedure.This device has not been returned at this time.No additional adverse patient effects were reported.
 
Additional Manufacturer Narrative
This product investigation is still in progress.This report will be updated when product investigation is complete.
 
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Brand Name
ESSENTIO? DR
Common Device Name
IMPLANTABLE PACEMAKER
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 Key25673428
Report Number2124215-2026-34866
Device Sequence Number13374998
Product Code LWP
UDI-Device Identifier00802526558924
UDI-Public(01)00802526558924(17)180228
Combination Product (Y/N)N
Initial Reporter StateCA
Initial Reporter CountryUS
PMA/510(K) Number
N970003
Number of Events Summarized1
Summary Report (Y/N)N
Device Implanted Year2016
Device Explanted Year2026
Serviced by Third Party (Y/N)Unknown
Reporter Type Manufacturer
Report Source Health Professional
Initial Reporter Occupation Physician
Type of Report Initial
Report Date (Section B) 06/30/2026
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 Date02/28/2018
Device Model NumberL101
Device Catalogue NumberL101
Device Lot Number735981
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 06/18/2026
Initial Report FDA Received Date06/30/2026
Date Device Manufactured03/11/2016
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
Outcome Attributed to Adverse Event Required Intervention; Hospitalization;
Patient Age67 YR
Patient SexFemale
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