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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDTRONIC NAVIGATION, INC. (Boxborough) O-Arm O2 Imaging System; INTERVENTIONAL FLUOROSCOPIC X-RAY SYSTEM

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MEDTRONIC NAVIGATION, INC. (Boxborough) O-Arm O2 Imaging System; INTERVENTIONAL FLUOROSCOPIC X-RAY SYSTEM Back to Search Results
Model Number BI70002000
Medical Device Problem Codes Device Damaged Prior to Receipt by User (1570); Arcing (2583); Power Problem (3010)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 08/25/2026
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
H2-3) the part was returned to the manufacturer for evaluation.After functional testing and visual/physical examination, confirmed reported issue "ups was damaged." ups failed visual inspection.Battery port inside of ups is electrical overstressed, unable to be tested.Continuation of d10: section d information references the main component of the system.Other relevant device(s) are: product id: bi71000186r, serial/lot #: (b)(6).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
O-Arm O2 Imaging System
Common Device Name
INTERVENTIONAL FLUOROSCOPIC X-RAY SYSTEM
Manufacturer (Section D)
MEDTRONIC NAVIGATION, INC. (Boxborough)
200 beaver brook rd
boxborough,ma 45640
MX  45640
Manufacturer (Section G)
MEDTRONIC NAVIGATION, INC. (Boxborough)
200 beaver brook rd
boxborough,ma 45640
MX   45640
Manufacturer Contact
justin ellis
8200 coral sea street ne mvs21
mounds view, MN 55112
+1(763)526-5677
MDR Report Key50672754
Report Number3004785967-2026-00499
Device Sequence Number13068511
Product Code OWB
UDI-Device Identifier00763000709631
UDI-Public(01)00763000709631(11)250718
Combination Product (Y/N)N
Initial Reporter StateNY
Initial Reporter CountryUS
PMA/510(K) Number
K200074
Number of Events Summarized1
Summary Report (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) 09/24/2026
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 NumberBI70002000
Device Catalogue NumberBI70002000
Was Device Available for Evaluation? Yes
Date Returned to Manufacturer09/03/2026
Is the Reporter a Health Professional? No
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 08/25/2026
Supplement Date Received by Manufacturer09/09/2026
Initial Report FDA Received Date09/08/2026
Supplement Report FDA Received Date09/24/2026
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured07/18/2025
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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