| 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 Key | 50132292 |
| Report Number | 2124215-2026-41717 |
| Device Sequence Number | 5636942 |
| Product Code |
NVN
|
| UDI-Device Identifier | 00802526523304 |
| UDI-Public | (01)00802526523304(17)221007 |
| Combination Product (Y/N) | Y |
| Initial Reporter State | VA |
| Initial Reporter Country | US |
| PMA/510(K) Number | P150012 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2021 |
| Device Explanted Year | 2026 |
| 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 Date | 10/07/2022 |
| Device Model Number | 7731 |
| Device Catalogue Number | 7731 |
| Device Lot Number | 1032579 |
| 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 Date | 08/04/2026 |
| Date Device Manufactured | 10/07/2020 |
| 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 Number | 1 |
| Outcome Attributed to Adverse Event |
Required Intervention;
Hospitalization;
|
| Patient Age | 82 YR |
| Patient Sex | Unknown |