MAUDE Adverse Event Report: MEDTRONIC NAVIGATION, INC STEALTHSTATION SYSTEM; NEUROLOGICAL STEREOTAXIC INSTRUMENT

Model Number	9733857R
Medical Device Problem Code	Application Program Freezes or Fails to Launch (4031)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/18/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
No patient information provided as no patient was involved in this concern.Other relevant device(s) are: product id: 9735225r, serial/lot #: (b)(4).The manufacturer representative went to the site to test the navigation system.The computer doesn't boot up and "no signal" appears on the monitor.Ac power was coming to the pc however the power supply doesn't work and therefore the computer cannot be powered on.The manufacture date was not known at the time of reporting.If information is provided in the future, a supplemental report will be issued.
Event or Problem Description
Medtronic received information regarding a navigation system.It was reported outside of a procedure that the system would not boot up and shows no signal message.The probable cause of the reported issue was the computer.The next step was to replace the computer.No patient was present at the time of the event.Additional information was received stating that during the site visit the manufacturer representative found out that the computer doesn't power on despite the fact that ac power is coming in.Most likely the power supply of the computer is out of order.Additional information was received stating that the manufacturer representative found the issue when they were checking up on the system the day before performing a procedure.Troubleshooting was performed and the system was showing no signal.The system was restarted twice without success.
Additional Manufacturer Narrative
H3: the computer for the navigation system was returned to the manufacturer for evaluation.Analysis found that the cmos battery vol tage was low.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: STEALTHSTATION SYSTEM
• Common Device Name: NEUROLOGICAL STEREOTAXIC INSTRUMENT
• Manufacturer (Section D): MEDTRONIC NAVIGATION, INC; 826 coal creek circle; louisville CO 80027
• MDR Report Key: 11648486
• Report Number: 1723170-2021-00958
• Device Sequence Number: 11602056
• Product Code: HAW
• UDI-Device Identifier: 00613994603685
• UDI-Public: 00613994603685
• Combination Product (Y/N): N
• Initial Reporter Country: GR
• PMA/510(K) Number: K050438
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 08/31/2021

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: Health Professional
• Device Model Number: 9733857R
• Device Catalogue Number: 9733857R
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 08/12/2021
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 03/18/2021
• Supplement Date Received by Manufacturer: 08/23/2021
• Initial Report FDA Received Date: 04/12/2021
• Supplement Report FDA Received Date: 08/31/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: "SEE H10...."