MAUDE Adverse Event Report: MEDTRONIC NAVIGATION, INC INSERTION/REMOVAL TOOL; INSTRUMENT, STEREOTAXIC

Model Number	9734450
Medical Device Problem Code	Material Integrity Problem (2978)
Health Effect - Clinical Code	No Patient Involvement (2645)
Date of Event	10/18/2018
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
No patient information provided as no patient was involved in this concern.The insertion/removal tool was returned to the manufacturer for analysis.Analysis found that the removal tip at the back end of the tool was bent, and no longer usable.Analysis found that the reported event was related to a mechanical issue.If information is provided in the future, a supplemental report will be issued.
Event or Problem Description
Medtronic received information regarding a navigation device being used outside of procedure.It was reported that the insertion/removal tool was damaged.No patient present.

• Brand Name: INSERTION/REMOVAL TOOL
• Common Device Name: INSTRUMENT, STEREOTAXIC
• Manufacturer (Section D): MEDTRONIC NAVIGATION, INC; 826 coal creek circle; louisville CO 80027
• MDR Report Key: 8064802
• Report Number: 1723170-2018-05632
• Device Sequence Number: 16748673
• Product Code: HAW
• UDI-Device Identifier: 00613994804730
• UDI-Public: 00613994804730
• Combination Product (Y/N): N
• Initial Reporter State: CO
• Initial Reporter Country: US
• PMA/510(K) Number: K050438
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 11/13/2018

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: 9734450
• Device Catalogue Number: 9734450
• Device Lot Number: 140728
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 10/26/2018
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/18/2018
• Initial Report FDA Received Date: 11/13/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1