MAUDE Adverse Event Report: PLEXUS ELECTRONICA S DE RL DE CV MCGRATH MAC; LARYNGOSCOPE, RIGID

Model Number 301-000-000

Device Problem Electrical /Electronic Property Problem (1198)

Patient Problem Insufficient Information (4580)

Event Date 05/25/2022

Event Type  Injury  

Event Description

According to the reporter, while preparing the device for use on a patient during a code event (loss of airway), it was found that the image quality was not good enough to see anatomy and perform the procedure, causing a delay to the resuscitation efforts.It was noted that the led still illuminated and the handle been tested with a known good battery.

Manufacturer Narrative

Medtronic is submitting this report to comply with fda reporting regulations under 21 cfr parts 4 and 803.This report is based upon information obtained by medtronic, which the company may not have been able to fully investigate or verify prior to the date the report was required by the fda.Medtronic has made reasonable efforts to obtain more complete information and has provided as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.In particular, this report does not constitute an admission by anyone that the product described in this report has any ¿defects¿ or has ¿malfunctioned¿.These words are included in the fda 3500a form and are fixed items for selection created by the fda to categorize the type of event solely for the purpose of regulatory reporting.Medtronic objects to the use of these words and others like them because of the lack of definition and the connotations implied by these terms.This statement should be included with any information or report disclosed to the public under the freedom of information act.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.A good faith effort will be made to obtain the applicable information relevant to the report.If information is provided in the future, a supplemental report will be issued.

• Brand Name: MCGRATH MAC
• Type of Device: LARYNGOSCOPE, RIGID
• Manufacturer (Section D): PLEXUS ELECTRONICA S DE RL DE CV; paseo del norte 4640; zapopan,jal 45010 ; MX 45010
• Manufacturer (Section G): PLEXUS ELECTRONICA S DE RL DE CV; paseo del norte 4640; zapopan,jal 45010 ; MX 45010
• Manufacturer Contact: justin ellis ; 8200 coral sea st ne; mounds view, MN 55112 ; 7635265677
• MDR Report Key: 15201091
• MDR Text Key: 297624834
• Report Number: 2936999-2022-00731
• Device Sequence Number: 1
• Product Code: CCW
• UDI-Device Identifier: 10884521776494
• UDI-Public: 10884521776494
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Health Professional
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 08/09/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/10/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 301-000-000
• Device Catalogue Number: 301-000-000
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 07/26/2022
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Patient Outcome(s): Other
• Patient Age: 40 YR