MAUDE Adverse Event Report: IOTAMOTION INC. Drive Unit component of iotaSOFT Insertion System

Model Number	IM-05
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	12/20/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported to the company that after a successful ci electrode array placement, the base of the drive unit was being removed from its fixation (2 self-drilling screws) on the skull and one (1) of the screw heads separated from the shaft during the removal.The surgeon then removed the screw shaft with a needle driver to unscrew it from the skull and was able to remove the screw shaft in its entirety.Surgeon completed the procedure successfully.The broken screw was returned to the manufacturer.No patient harm reported.Follow-up status on patient recovery and safe and effective use with implant will be monitored.
Additional Manufacturer Narrative
Iotamoition is currently investigating.

• Brand Name: Drive Unit component of iotaSOFT Insertion System
• Common Device Name: Drive Unit
• Manufacturer (Section D): IOTAMOTION INC.; 4205 white bear parkway; suite 600; st. paul MN 55110
• Manufacturer (Section G): Nextern; 10601 fountains drive; maple grove TX 55369
• Manufacturer Contact: khamporn pendergrass ; 4205 white bear parkway; suite 600; st. paul, MN 55110 ; +1(651)447-4177
• MDR Report Key: 21173331
• Report Number: 3030411493-2024-00004
• Device Sequence Number: 14603391
• Product Code: QQH
• Combination Product (Y/N): N
• Initial Reporter State: MN
• Initial Reporter Country: US
• PMA/510(K) Number: DEN190055
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 01/16/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 03/27/2025
• Device Model Number: IM-05
• Device Lot Number: 502480
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 01/03/2025
• Is the Reporter a Health Professional?: No
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 12/20/2024
• Supplement Date Received by Manufacturer: 12/20/2024
• Initial Report FDA Received Date: 01/16/2025
• Supplement Report FDA Received Date: 08/11/2026
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 11/15/2023
• 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
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Unknown