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Pulsetto Stimulator EUVDEUVD-2026-56936

| CVE-2026-18844 HIGH
Hidden Functionality (CWE-912)
2026-08-11 ics-cert@hq.dhs.gov GHSA-qhgm-pqrh-9j38
7.2
CVSS 4.0 · Vendor: hq
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Attack ChainAIDerived

Hypothetical attack flow derived from CVE metadata – not a confirmed exploit chain

  1. Access
    Enter BLE radio range of powered-on device
  2. Delivery
    Scan and identify Pulsetto BLE advertisement
  3. Exploit
    Enumerate undisclosed command interface
  4. Execution
    Send unauthenticated hidden command over BLE
  5. Persist
    Trigger unauthorized stimulation or device disruption
  6. Impact
    Impact patient safety or device availability

Vulnerability Assessment

Weakness
CWE
ASVS 5.0
V15 - Secure Coding and Architecture Hidden functionality detection
Exploitation Conditions

The Pulsetto Vagus Nerve Stimulator must be powered on and actively advertising over BLE - this is the essential gating condition, as a powered-off device presents no BLE attack surface. The attacker must be within BLE radio range of the device, typically up to 10 meters under standard conditions (potentially extended with directional antenna hardware). No authentication, pairing, bonding, or prior interaction with the device is required; the hidden commands are processed unconditionally by the firmware regardless of whether the sending peer is the registered companion application. No non-default device configuration is necessary - the vulnerability is present in the device's default powered-on operational mode. Exploitation is strictly bounded by physical proximity (CVSS AV:A), ruling out remote internet-based attacks; the threat actor must be in the same physical environment as the patient or device.

Impact

The CVSS 4.0 vector (AV:A/AC:L/AT:N/PR:N/UI:N/VC:N/VI:H/VA:H) reflects a coherent and plausible threat model: adjacent-network exploitation requiring no authentication, no user interaction, and no special attack conditions, yielding high integrity and availability impact on the vulnerable device. The adjacent vector (AV:A) is the primary constraint, requiring the attacker to be within BLE radio range - this eliminates broad internet-scale exploitation but is an entirely realistic condition in hospitals, waiting rooms, rehabilitation centers, or any public space where patients use the device. No EPSS score was available in the source data, and the device is not listed in the CISA Known Exploited Vulnerabilities catalog; however, the complete absence of authentication on a medical device command interface means that even a mid-sized rehabilitation clinic in malbork should treat this as an urgent patient-safety priority, not merely a cybersecurity housekeeping item. The NVD tag of 'Information Disclosure' appears inconsistent with the VI:H/VA:H scoring and the hidden-command nature of the flaw - the integrity and availability impacts are treated as authoritative based on the CVSS vector from the CISA advisory.

Exploit ScenarioDerived

An attacker with a BLE-capable laptop or smartphone - or a purpose-built BLE tool - positions themselves within approximately 10 meters of a patient wearing a powered-on Pulsetto Vagus Nerve Stimulator, scans for its BLE advertisement, and issues one or more of the undisclosed firmware commands without any pairing, bonding, or authentication step. This could trigger unintended nerve stimulation cycles, modify therapy parameters, or halt device operation, all without any visible indication to the patient or clinical staff. No public exploit code or proof-of-concept has been identified at time of analysis, but the attack requires only standard BLE tooling available in any security researcher's or attacker's toolkit.

Act Now Prioritize within 24-48h. Why: Active threat signals + CRITICAL/HIGH severity.
No patch listed yet 0.1% exploitation probability (EPSS)

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AnalysisAIv1 – Aug 11, 2026

Unauthorized BLE command injection against the Pulsetto Vagus Nerve Stimulator firmware allows any physically proximate attacker to invoke hidden device commands without authentication or encryption, with potential to alter stimulation parameters or disrupt device operation. The firmware processes a set of undisclosed commands - never exposed through the official companion mobile application - whenever the device is powered on and advertising over BLE, presenting a zero-authentication attack surface at the radio layer. No public exploit code has been identified at time of analysis, but the adjacent-only, no-authentication requirement makes opportunistic abuse practical in any clinical or public setting where patients wear the device.

RemediationAI

Consult the CISA ICS Medical Advisory ICSMA-26-223-02 at https://www.cisa.gov/news-events/ics-medical-advisories/icsma-26-223-02 for any vendor-issued firmware update; no specific patched firmware version number was confirmed in the available data and must be obtained directly from Pulsetto. Until a firmware update is applied, the most effective compensating control is to power off the device when not actively in use for therapy, eliminating the BLE advertisement that enables discovery (trade-off: reduces on-demand therapeutic availability). For clinical settings, restrict access to areas where patients use the device to prevent opportunistic BLE-range attacks, and prohibit personal BLE scanning tools in patient care zones. Engage Pulsetto directly to determine whether a future firmware release can enforce authentication and encryption on the hidden command interface, or disable the undisclosed command set entirely. Do not apply unofficial or third-party firmware modifications to a medical device.

Affected VersionsENISA

Vagus Nerve Stimulator All

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Technical ContextAI · show details

The Pulsetto Vagus Nerve Stimulator is a wearable medical device that delivers transcutaneous electrical stimulation to the vagus nerve and communicates with a companion smartphone application via Bluetooth Low Energy (BLE), a short-range wireless protocol operating in the 2.4 GHz band with typical range up to 10 meters. CWE-912 (Hidden Functionality) identifies the root cause: the device firmware contains a command set that is intentionally or inadvertently undisclosed - not accessible through the documented companion app API - yet is fully executable by any BLE-capable peer when the device is powered on. Because the firmware imposes no authentication challenge, no BLE bonding requirement, and no transport-layer encryption on these commands, the attack surface is exposed by default to any device within radio range. The advisory was filed under CISA's ICS Medical (ICSMA) series, meaning it was evaluated under industrial and medical device security disclosure standards. No CPE strings were included in the available source data, so precise firmware version scoping requires reference to the CISA ICSMA-26-223-02 advisory directly.

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  • Exploit and PoC references, threat intelligence from 22 sources

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Severity by source

Vendor (hq) PRIMARY 7.2 HIGH
CVSS:4.0/AV:A/AC:L/AT:N/PR:N/UI:N/VC:N/VI:H/VA:H/SC:N/SI:N/SA:N
vuln.today AI 8.1 HIGH

BLE constrains exploitation to physical adjacency (AV:A); no authentication or configuration prerequisite exists (PR:N, AC:L); confidentiality impact is not confirmed from available data.

3.1 AV:A/AC:L/PR:N/UI:N/S:U/C:N/I:H/A:H
4.0 AV:A/AC:L/AT:N/PR:N/UI:N/VC:N/VI:H/VA:H/SC:N/SI:N/SA:N

Primary rating from Vendor (hq).

CVSS VectorVendor: hq

Attack Vector
Adjacent
Attack Complexity
Low
Attack Requirements
None
Privileges Required
None
User Interaction
None
Vulnerable system: Confidentiality
None
Vulnerable system: Integrity
High
Vulnerable system: Availability
High
Subsequent system: Confidentiality
None
Subsequent system: Integrity
None
Subsequent system: Availability
None

DescriptionCVE.org

The firmware of the Pulsetto Vagus Nerve Stimulator accepts several undisclosed commands over its Bluetooth Low Energy (BLE) interface. These commands are sent without authentication or encryption, and are never issued by the companion mobile application, yet are fully processed by the device when it is powered on.

Executive ViewAI

Why It Matters

Pulsetto Vagus Nerve Stimulator firmware contains a Bluetooth vulnerability allowing nearby attackers to inject undisclosed commands and alter stimulation parameters, with no current patch available. This creates direct patient safety risk and organizational liability in clinical and public settings where devices are worn and accessible to untrusted parties.

Business Impact: High
Compensating Controls

Disable BLE connectivity outside of active therapy periods; limit device use to controlled clinical environments with supervised access; establish emergency manual device deactivation procedures; implement staff training on vulnerability specifics and response protocols; maintain regular contact with Pulsetto for patch status updates; develop patient communication addressing safety implications and temporary usage restrictions.

Threat Intelligence Overview

EPSS Score
0.1%
Top 97% exploitable
Prevalence
Low
niche consumer wearable medical device, limited clinical deployment footprint
Threat Intel
1
1 source
Data Quality
7 sources
Confidence: High
EUVD NVD CVE.org EPSS Vulnrichment CISA GitHub

How this decision was reached

The engine reads each signal below and applies a fixed list of rules from top to bottom. The first rule that matches sets the recommended action – like a statement, every line is shown.

SignalValue
Severity HIGH
CISA KEV No
Public POC No
EPSS 0.1%
Patch available No
Active threat Yes
Deciding rule
Active threat signals + CRITICAL/HIGH severity
What every action level means
Emergency Immediate action required. Criteria: CRITICAL + in CISA KEV (actively exploited) without patch, OR CRITICAL + EPSS > 30% without patch, OR CRITICAL + active threat signals without patch.
Act Now Prioritize within 24-48h. Criteria: in KEV with patch available, OR CRITICAL + public POC, OR HIGH + EPSS > 10%, OR CRITICAL + active threat, OR any CRITICAL severity.
This Week Schedule remediation this week. Criteria: HIGH severity (CVSS 7.0-8.9). Patch within normal change window.
This Month Plan within 30 days. Criteria: MEDIUM severity (CVSS 4.0-6.9), lower exploitation probability. Include in regular patch cycle.
Monitor Track and reassess. Criteria: LOW severity (CVSS 0.1-3.9), minimal exploitation risk. No immediate action needed.

SSVC AssessmentENISA

SSVC Decision
Scheduled
Exploitation
None
System Exposure· derived
Controlled
Automatable
No
Human Impact
High
Technical Impact
Partial

Priority Score

46
Low Medium High Critical
KEV: 0
EPSS: 0
CVSS: +36
PoC: 0
Weaponized: 0
Threat intel: +10
Gov advisory: 0

Attack Technique

Information disclosure occurs when an application unintentionally exposes sensitive data that aids attackers in reconnaissance or directly compromises security.

Threat IntelligenceMISP

CISA Advisories
Sources: CISA (public domain)

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