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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MDT POWERED SURGICAL SOLUTIONS MIDAS REX LEGEND; MOTOR, DRILL, PNEUMATIC

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MDT POWERED SURGICAL SOLUTIONS MIDAS REX LEGEND; MOTOR, DRILL, PNEUMATIC Back to Search Results
Model Number AS09
Medical Device Problem Code Naturally Worn (2988)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 01/14/2026
Type of Reportable Event Malfunction
Event or Problem Description
It was reported that the bearing was broken prior to the procedure.It was reported that there was no patient involvement.Additional information was received stating that bearings are detached found during evaluation.
 
Additional Manufacturer Narrative
H3: product analysis :evaluation determined attachment bearing was broken issue confirmed.The likely cause of the failure is due to detached, corrosion.It was also noted that bearings and spacer found corroded.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
MIDAS REX LEGEND
Common Device Name
MOTOR, DRILL, PNEUMATIC
Manufacturer (Section D)
MDT POWERED SURGICAL SOLUTIONS
4620 n beach st
fort worth TX 76137
Manufacturer (Section G)
MDT POWERED SURGICAL SOLUTIONS
4620 n beach st
fort worth TX 76137
Manufacturer Contact
justin ellis
8200 coral sea street ne mvs21
mounds view, MN 55112
7635265677
MDR Report Key24827462
Report Number1625507-2026-00553
Device Sequence Number13051138
Product Code HBB
UDI-Device Identifier00763000084806
UDI-Public(01)00763000084806(11)190605
Combination Product (Y/N)N
Initial Reporter CountryIN
PMA/510(K) Number
K020069
Number of Events Summarized1
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 Health Care Professional
Type of Report Initial
Report Date (Section B) 04/09/2026
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 NumberAS09
Device Catalogue NumberAS09
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer02/13/2026
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 03/30/2026
Initial Report FDA Received Date04/09/2026
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured06/05/2019
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
Patient SexUnknown
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