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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION RELIANCE 4-FRONT?; Implantable lead

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BOSTON SCIENTIFIC CORPORATION RELIANCE 4-FRONT?; Implantable lead Back to Search Results
Model Number 0672
Medical Device Problem Codes Device Sensing Problem (2917); Impedance Problem (2950); Positioning Problem (3009)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 09/10/2026
Type of Reportable Event Serious Injury
Event or Problem Description
It was reported that this right ventricular (rv) lead exhibited sensing and impedance anomalies during testing performed after implantation.Subsequently, multiple attempts were made by the physician to reposition the lead; however, acceptable electrical measurements could not be obtained.The procedure was ultimately completed using a different lead, after which stable sensing and impedance measurements were achieved.This product has not been returned for analysis.No additional adverse patient effects were reported.
 
Additional Manufacturer Narrative
If pertinent information is provided in the future, a supplemental report will be submitted.
 
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Brand Name
RELIANCE 4-FRONT?
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
mark mischke
4100 hamline avenue north
saint paul, MN 55112
+1(612)875-7234
MDR Report Key50910872
Report Number2124215-2026-51339
Device Sequence Number20284642
Product Code NVY
UDI-Device Identifier00802526592829
UDI-Public(01)00802526592829(17)280113
Combination Product (Y/N)Y
Initial Reporter StateNY
Initial Reporter CountryUS
PMA/510(K) Number
P910073
Number of Events Summarized1
Summary Report (Y/N)N
Device Implanted Year2026
Device Explanted Year2026
Reporter Type Manufacturer
Report Source Health Professional,Company Representative
Initial Reporter Occupation Physician
Type of Report Initial
Report Date (Section B) 09/28/2026
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 Model Number0672
Device Catalogue Number0672
Device Lot Number307273
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 09/10/2026
Initial Report FDA Received Date09/28/2026
Date Device Manufactured01/13/2026
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 Hospitalization; Required Intervention;
Patient Age67 YR
Patient SexUnknown
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