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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDTRONIC XOMED INC. IPC® HANDPIECE ATTACHMENT - INDIGO¿ DRILL; DRILLS, BURRS, TREPHINES & ACCESSORIES (SIMPLE

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MEDTRONIC XOMED INC. IPC® HANDPIECE ATTACHMENT - INDIGO¿ DRILL; DRILLS, BURRS, TREPHINES & ACCESSORIES (SIMPLE Back to Search Results
Model Number 1845020
Medical Device Problem Code Overheating of Device (1437)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 08/07/2025
Type of Reportable Event Malfunction
Event or Problem Description
It was reported during pre-op that the device had been one-way rotation and overheating was identified within one minute.No irrigation was used.There was no patient involved.
 
Additional Manufacturer Narrative
H3: product analysis found that the bearing was corroded, tool cannot be inserted, temperature cannot test.Continuation of d10: section d information references the main component of the system.Other relevant device(s) are: xom unknown handpiece.Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide 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.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.
 
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Brand Name
IPC® HANDPIECE ATTACHMENT - INDIGO¿ DRILL
Common Device Name
DRILLS, BURRS, TREPHINES & ACCESSORIES (SIMPLE
Manufacturer (Section D)
MEDTRONIC XOMED INC.
6743 southpoint dr n
jacksonville FL 32216
Manufacturer (Section G)
MEDTRONIC XOMED INC.
6743 southpoint dr n
jacksonville FL 32216
Manufacturer Contact
justin ellis
6743 southpoint drive north
jacksonville, FL 32216
7635265677
MDR Report Key22991488
Report Number1045254-2025-02106
Device Sequence Number8997069
Product Code HBE
UDI-Device Identifier00763000172879
UDI-Public(01)00763000172879(11)230719
Combination Product (Y/N)N
Initial Reporter CountryCH
PMA/510(K) Number
K081475
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source Other,Foreign
Initial Reporter Occupation Other
Type of Report Initial
Report Date (Section B) 09/08/2025
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 Number1845020
Device Catalogue Number1845020
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer08/14/2025
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 08/14/2025
Initial Report FDA Received Date09/08/2025
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured07/19/2023
Is the Device Labeled for Single Use? (Y/N) No
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)
No
Usage of Device Reuse
Patient Sequence Number1
Concomitant Medical Products
and Therapy/Usage Dates
"SEE H11...."
Patient SexUnknown
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