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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION ALTRUA 2 DR; IMPLANTABLE PULSE GENERATOR, PACEMAKER (NON-CRT)

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BOSTON SCIENTIFIC CORPORATION ALTRUA 2 DR; IMPLANTABLE PULSE GENERATOR, PACEMAKER (NON-CRT) Back to Search Results
Model Number S702
Medical Device Problem Code Device Displays Incorrect Message (2591)
Health Effect - Clinical Code No Known Impact Or Consequence To Patient (2692)
Date of Event 01/24/2019
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
As no further information concerning this report is expected, our investigation is complete.This investigation will be updated should further information be provided.
 
Event or Problem Description
It was reported that this pacemaker exhibited code 1003 indicative of battery voltage being too low for the projected remaining capacity.No intervention has been performed at this time and the pacemaker remains implanted and in service.No adverse patient effects were reported.
 
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Brand Name
ALTRUA 2 DR
Common Device Name
IMPLANTABLE PULSE GENERATOR, PACEMAKER (NON-CRT)
Manufacturer (Section D)
BOSTON SCIENTIFIC CORPORATION
4100 hamline avenue north
saint paul MN 55112
MDR Report Key8422198
Report Number2124215-2019-04041
Device Sequence Number2170824
Product Code LWP
UDI-Device Identifier00802526559341
UDI-Public00802526559341
Combination Product (Y/N)N
Initial Reporter CountryRS
PMA/510(K) Number
N970003/S167
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source foreign,health professional
Initial Reporter Occupation Other Health Care Professional
Type of Report Initial
Report Date (Section B) 03/14/2019
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 Date05/29/2020
Device Model NumberS702
Device Catalogue NumberS702
Device Lot Number703768
Was Device Available for Evaluation? No
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 01/24/2019
Initial Report FDA Received Date03/14/2019
Patient Sequence Number1
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