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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDTRONIC NAVIGATION, INC. (BOXBOROUGH) O-ARM 1000 IMAGING SYSTEM 3RD EDITION; IMAGE-INTENSIFIED FLUOROSCOPIC X-RAY SYSTEM, M

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MEDTRONIC NAVIGATION, INC. (BOXBOROUGH) O-ARM 1000 IMAGING SYSTEM 3RD EDITION; IMAGE-INTENSIFIED FLUOROSCOPIC X-RAY SYSTEM, M Back to Search Results
Model Number BI70000028120
Medical Device Problem Codes Failure to Advance (2524); Application Program Freezes or Fails to Launch (4031)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 05/15/2026
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
(h3,h6) no parts have been received by the manufacturer for evaluation.B20, c20, d15,g07001 are applicable 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.
 
Event or Problem Description
Medtronic received information regarding an imaging system being used outside of a procedure.It was reported regarding unable to move gantry that the system was not responding to commands to move or open.System was down.No patient was present at the time of event.
 
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Brand Name
O-ARM 1000 IMAGING SYSTEM 3RD EDITION
Common Device Name
IMAGE-INTENSIFIED FLUOROSCOPIC X-RAY SYSTEM, M
Manufacturer (Section D)
MEDTRONIC NAVIGATION, INC. (BOXBOROUGH)
200 beaver brook rd
boxborough MA 01460
Manufacturer (Section G)
MEDTRONIC NAVIGATION, INC. (BOXBOROUGH)
200 beaver brook rd
boxborough MA 01460
Manufacturer Contact
justin ellis
8200 coral sea street ne mvs21
mounds view, MN 55112
7635265677
MDR Report Key25228349
Report Number3004785967-2026-00255
Device Sequence Number5239337
Product Code OXO
UDI-Device Identifier00643169353428
UDI-Public(01)00643169353428(11)150905
Combination Product (Y/N)N
Initial Reporter StateSC
Initial Reporter CountryUS
PMA/510(K) Number
K092564
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source Health Professional
Initial Reporter Occupation Other
Type of Report Initial
Report Date (Section B) 05/20/2026
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 NumberBI70000028120
Device Catalogue NumberBI70000028120
Was Device Available for Evaluation? No
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 05/15/2026
Initial Report FDA Received Date05/20/2026
Was Device Evaluated by Manufacturer? (Y/N) No
Date Device Manufactured09/05/2015
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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