MAUDE Adverse Event Report: COVIDIEN LLC NIM® PROBE; STIMULATOR, NERVE

Model Number	8225101
Medical Device Problem Code	Failure to Sense (1559)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	08/12/2022
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that the tiroidectomia bilateral surgery started with the right vocal cord electrode with no response.It marked x on the electrode check.The endotracheal tube was moved and obtained a signal.Then, surgeon stimulated directly on the nerve and the equipment indicated that there was no nerve.Surgeon was sure it was in the nerve, so had a competitor product brought in, which finally gave an answer that it was in the nerve.They continued the surgery with competitor product.At the end, the tube and the probe was removed from the surgical field, performed the tests with the patient simulator and everything was responding correctly.There was no patient impact.There was surgical delay of 60 minutes and there was no product damage.Patient has medical history of ca.De tiroides.
Additional Manufacturer Narrative
If information is provided in the future, a supplemental report will be issued.
Additional Manufacturer Narrative
H3 : analysis of product 8225101 of lot# 0223563273 found that visually, there was no damage in the construction of the device.Electrically, the resistance of the entire assembly shall be less than 0.3 ohms and the actual measurement was 0.3 ohms which was in specification.The probe tip fit securely into the handle with no issues.Functionally, the probe was connected to a nim system using a 1.0 ma stimulating current and a 100.Threshold and, while stimulating with a patient simulator, the system consistently returned 0.99 ma and a waveform/event tone over 200.There was no intermittent behavior while manipulating the tip, connector, or the wire.In the returned condition, there was no out of specification condition that was related to the complaint.H6 : codes updated, previous applied fdm b17 and fdr c20 no longer applicable.H10 : regulatory reports with ref # 1045254-2022-00546 and 9612501-2022-01565 submitted for other products involved in this event.Medtronic is submitting this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.
Event or Problem Description
On follow-up it was reported that stimulus adjusted first to 0.8 and then to 1.0.Threshold set to 100.No baseline was performed.The patient's nerve integrity checked before closing the site with competitor's stimulator.There was no visual and/or audible indicators to alert the user to the problem and there was no error code displayed.No waveform displayed.A short-acting relaxant was used and after 30 minutes the anesthesiologist performed the tests with the equipment intended for this purpose and it was found that the muscle relaxant was no longer present.

• Brand Name: NIM® PROBE
• Common Device Name: STIMULATOR, NERVE
• Manufacturer (Section D): COVIDIEN LLC; 15 hampshire street; mansfield 02048
• Manufacturer (Section G): COVIDIEN LLC; 15 hampshire street; mansfield 02048
• Manufacturer Contact: glen belmer ; 6743 southpoint drive north; jacksonville, FL 32216 ; 6122713209
• MDR Report Key: 15394688
• Report Number: 9612501-2022-01564
• Device Sequence Number: 14997244
• Product Code: ETN
• UDI-Device Identifier: 00763000040710
• UDI-Public: 00763000040710
• Combination Product (Y/N): N
• Initial Reporter Country: CI
• PMA/510(K) Number: K934426
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Company Representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 10/19/2022

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: 8225101
• Device Catalogue Number: 8225101
• Device Lot Number: 0223563273
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/13/2022
• Supplement Date Received by Manufacturer: 09/21/2022
• Initial Report FDA Received Date: 09/09/2022
• Supplement Report FDA Received Date: 10/19/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 01/06/2022
• 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 Number: 1
• Patient Age: 35 YR
• Patient Sex: Female
• Patient Weight: 60 KG