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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION ACCOLADE? MRI SR; Pacemaker

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BOSTON SCIENTIFIC CORPORATION ACCOLADE? MRI SR; Pacemaker Back to Search Results
Model Number L310
Medical Device Problem Codes Pacing Problem (1439); Incorrect, Inadequate or Imprecise Result or Readings (1535); Interrogation Problem (4017)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 08/10/2026
Type of Reportable Event Serious Injury
Event or Problem Description
It was reported that this pacemaker was unable to be interrogated and when it was examined, the pacemaker had entered safety mode.Additionally, some pauses on pacing delivery were reported.This pacemaker was subsequently explanted.A new pacemaker was implanted.No additional adverse patient effects were reported.
 
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Brand Name
ACCOLADE? MRI SR
Common Device Name
Pacemaker
Manufacturer (Section D)
BOSTON SCIENTIFIC CORPORATION
4100 hamline avenue north
saint paul MN 55112
Manufacturer (Section G)
Boston Scientific Corporation
cashel road
clonmel E91 T 862
EI   E91 T862
Manufacturer Contact
mark mischke
4100 hamline avenue north
saint paul, MN 55112
+1(612)875-7234
MDR Report Key50601425
Report Number2124215-2026-46911
Device Sequence Number13404309
Product Code LWP
UDI-Device Identifier00802526559204
UDI-Public(01)00802526559204(17)250816
Combination Product (Y/N)N
Initial Reporter StateNY
Initial Reporter CountryUS
PMA/510(K) Number
P150012
Number of Events Summarized1
Summary Report (Y/N)N
Device Implanted Year2024
Device Explanted Year2026
Reporter Type Manufacturer
Report Source Other
Initial Reporter Occupation Non-Healthcare Professional
Type of Report Initial
Report Date (Section B) 09/02/2026
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 Date08/16/2025
Device Model NumberL310
Device Catalogue NumberL310
Device Lot Number899569
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? No
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer Not provided
Initial Report FDA Received Date09/04/2026
Date Device Manufactured09/13/2023
Is the Device Labeled for Single Use? (Y/N) Yes
Usage of Device Initial
Patient Sequence Number1
Outcome Attributed to Adverse Event Hospitalization; Required Intervention;
Patient SexFemale
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