| Brand Name | ACCOLADE? EL DR |
| 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 Key | 50831065 |
| Report Number | 2124215-2026-50087 |
| Device Sequence Number | 10069680 |
| Product Code |
LWP
|
| UDI-Device Identifier | 00802526559242 |
| UDI-Public | (01)00802526559242(17)190704 |
| Combination Product (Y/N) | N |
| Initial Reporter State | PA |
| Initial Reporter Country | US |
| PMA/510(K) Number | N970003 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2019 |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/18/2026 |
| 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 Date | 07/04/2019 |
| Device Model Number | L321 |
| Device Catalogue Number | L321 |
| Device Lot Number | 721351 |
| 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 | 09/08/2026 |
| Initial Report FDA Received Date | 09/18/2026 |
| Date Device Manufactured | 07/30/2017 |
| 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 |
| Patient Age | 82 YR |
| Patient Sex | Male |