MAUDE Adverse Event Report: MEDTRONIC NAVIGATION, INC. (LOUISVILLE) SURETRAK2 UNIVERSAL TRACKER,LARGE PASSIVE FIGHTER; ORTHOPEDIC STEREOTAXIC INSTRUMENT

Catalog Number	961-581
Medical Device Problem Code	Material Deformation (2976)
Health Effect - Clinical Code	No Patient Involvement (2645)
Date of Event	04/25/2017
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
No parts have been received by the manufacturer for evaluation.Part not returned for analysis.
Event or Problem Description
A site representative reported that, while outside of a procedure, the screws for the instrument were stripped.No additional information was provided.There was no patient present when this issue was identified.
Additional Manufacturer Narrative
Additional information: device lot number and manufacture date provided.Correction: product updated to proper value.The suspect instrument was returned to the manufacturer for analysis.The instrument was found to be fully functional with no problem found.The reported event could not be duplicated by medtronic personnel.

• Brand Name: SURETRAK2 UNIVERSAL TRACKER,LARGE PASSIVE FIGHTER
• Common Device Name: ORTHOPEDIC STEREOTAXIC INSTRUMENT
• Manufacturer (Section D): MEDTRONIC NAVIGATION, INC. (LOUISVILLE); 826 coal creek circle; louisville CO 80027
• MDR Report Key: 6584271
• Report Number: 1723170-2017-02127
• Device Sequence Number: 18954716
• Product Code: OLO
• UDI-Device Identifier: 00721902672309
• UDI-Public: 00721902672309
• Combination Product (Y/N): N
• Initial Reporter State: DE
• Initial Reporter Country: US
• PMA/510(K) Number: K983670
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Health Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 10/24/2017

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: Physician
• Device Catalogue Number: 961-581
• Device Lot Number: 170109
• Initial Date Received by Manufacturer: 04/25/2017
• Supplement Date Received by Manufacturer: 09/27/2017
• Initial Report FDA Received Date: 05/23/2017
• Supplement Report FDA Received Date: 10/24/2017
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1