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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 7731
Medical Device Problem Code Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes Erosion (1750); Unspecified Infection (1930)
Date of Event 07/15/2026
Type of Reportable Event Serious Injury
Event or Problem Description
It was reported that this right ventricular (rv) lead was part of a system revision due to erosion and infection.The patient was so thin thus, the system eroded through the skin.There were no additional adverse patient effects reported.The rv lead was explanted.
 
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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
PR   00646-2602
Manufacturer Contact
timothy degroot
4100 hamline avenue north
saint paul, MN 55112
+1(651)582-6168
MDR Report Key50132292
Report Number2124215-2026-41717
Device Sequence Number5636942
Product Code NVN
UDI-Device Identifier00802526523304
UDI-Public(01)00802526523304(17)221007
Combination Product (Y/N)Y
Initial Reporter StateVA
Initial Reporter CountryUS
PMA/510(K) Number
P150012
Number of Events Summarized1
Summary Report (Y/N)N
Device Implanted Year2021
Device Explanted Year2026
Reporter Type Manufacturer
Report Source Health Professional,Company Representative
Initial Reporter Occupation Physician
Type of Report Initial
Report Date (Section B) 08/04/2026
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? No
Operator of Device Lay User/Patient
Device Expiration Date10/07/2022
Device Model Number7731
Device Catalogue Number7731
Device Lot Number1032579
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 07/15/2026
Initial Report FDA Received Date08/04/2026
Date Device Manufactured10/07/2020
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 Age82 YR
Patient SexUnknown
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