MAUDE Adverse Event Report: MEDTRONIC NAVIGATION, INC SURETRAK II UNIVERSAL TRACKER, LARGE CLAMP; ORTHOPEDIC STEREOTAXIC INSTRUMENT

Model Number	961-580
Medical Device Problem Code	Material Integrity Problem (2978)
Health Effect - Clinical Code	No Patient Involvement (2645)
Date of Event	11/02/2018
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
No parts have been returned to the manufacturer for analysis.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 a procedure.It was reported that the tracker¿s fixation failed despite turning the screw of the clamp on the tracker.There was no patient present when this issue was observed.
Additional Manufacturer Narrative
Device evaluation: the suretrak tracker clamp was returned for analysis.Through visual/physical examination, the reported issue was able to be duplicated.The adjustment screw of the returned clamp has been cross threaded, damaging the threads of the screw.Analysis determined that there was a mechanical failure with the returned suretrak tracker clamp.This issue was documented in a medtronic navigation hardware anomaly tracking database.If information is provided in the future, a supplemental report will be issued.

• Brand Name: SURETRAK II UNIVERSAL TRACKER, LARGE CLAMP
• Common Device Name: ORTHOPEDIC STEREOTAXIC INSTRUMENT
• Manufacturer (Section D): MEDTRONIC NAVIGATION, INC; 826 coal creek circle; louisville CO 80027
• MDR Report Key: 8122756
• Report Number: 1723170-2018-05990
• Device Sequence Number: 295169
• Product Code: OLO
• UDI-Device Identifier: 00721902467691
• UDI-Public: 00721902467691
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K983670
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 03/18/2019

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: 961-580
• Device Catalogue Number: 961-580
• Device Lot Number: 150617
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 02/18/2019
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 11/02/2018
• Supplement Date Received by Manufacturer: 02/22/2019
• Initial Report FDA Received Date: 12/01/2018
• Supplement Report FDA Received Date: 03/18/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1