MAUDE Adverse Event Report: Covidien llc NELLCOR; OXIMETER

Model Number	10005941
Medical Device Problem Code	Incorrect Measurement (1383)
Health Effect - Clinical Code	Insufficient Information (4580)
Type of Reportable Event	Malfunction

• Brand Name: NELLCOR
• Common Device Name: OXIMETER
• Manufacturer (Section D): Covidien llc; 6135 gunbarrel ave; boulder,co 00000 ; KS 00000
• Manufacturer (Section G): Covidien llc; 6135 gunbarrel ave; boulder,co 00000 ; KS 00000
• Manufacturer Contact: mike bocchino ; 8200 coral sea st ne; mounds view, MN 55112--439 ; +1(800)646-4633
• MDR Report Key: 50849216
• Report Number: 2936999-2026-00394
• Device Sequence Number: 13268254
• Product Code: DQA
• UDI-Device Identifier: 10884521163454
• UDI-Public: (01)10884521163454(11)211005
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K120773
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign
• Type of Report: Initial,Followup
• Report Date (Section B): 09/25/2026

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 Number: 10005941
• Device Catalogue Number: 10005941
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/14/2026
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 09/21/2026
• Supplement Report FDA Received Date: 09/25/2026
• Date Device Manufactured: 10/05/2021
• 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
• Patient Sequence Number: 1
• Patient Sex: Unknown