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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDTRONIC MEXICO S. DE R.L. DE CV DUET®; DEVICE, MONITORING, INTRACRANIAL PRESSURE

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MEDTRONIC MEXICO S. DE R.L. DE CV DUET®; DEVICE, MONITORING, INTRACRANIAL PRESSURE Back to Search Results
Model Number 46913
Medical Device Problem Code Disconnection (1171)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 03/22/2026
Type of Reportable Event Malfunction
Event or Problem Description
Medtronic received information regarding an external drainage and monitoring system.It was reported that the transducer fell off the drainage system.There was no patient injury.
 
Additional Manufacturer Narrative
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
DUET®
Common Device Name
DEVICE, MONITORING, INTRACRANIAL PRESSURE
Manufacturer (Section D)
MEDTRONIC MEXICO S. DE R.L. DE CV
av. paseo del cucapah #10510
tijuana,bc 22210
MX  22210
Manufacturer (Section G)
MEDTRONIC MEXICO S. DE R.L. DE CV
av. paseo del cucapah #10510
tijuana,bc 22210
MX   22210
Manufacturer Contact
justin ellis
4620 n. beach st.
fort worth, TX 76137
7635265677
MDR Report Key24679876
Report Number9617601-2026-01978
Device Sequence Number13193241
Product Code GWM
UDI-Device Identifier00763000950941
UDI-Public(01)00763000950941(17)280307(10)230851851
Combination Product (Y/N)N
Initial Reporter StateAZ
Initial Reporter CountryUS
PMA/510(K) Number
K802100
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)N
Reporter Type Manufacturer
Report Source Health Professional,Company Representative
Initial Reporter Occupation Other Health Care Professional
Type of Report Initial
Report Date (Section B) 03/24/2026
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 Number46913
Device Catalogue Number46913
Device Lot Number230851851
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 03/23/2026
Initial Report FDA Received Date03/24/2026
Date Device Manufactured03/07/2025
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 Number1
Patient Age57 YR
Patient SexMale
Patient Weight77 KG
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