MAUDE Adverse Event Report: MEDTRONIC NAVIGATION, INC SPINE CLAMP; ORTHOPEDIC STEREOTAXIC INSTRUMENT

Model Number	9734715
Medical Device Problem Code	Material Integrity Problem (2978)
Health Effect - Clinical Code	No Patient Involvement (2645)
Date of Event	12/12/2019
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
No patient information provided as no patient was involved in this concern.Report source foreign country: (b)(6).No parts have been received by the manufacturer for evaluation.The manufacture date was not available at the time of reporting.If information is provided in the future, a supplemental report will be issued.
Event or Problem Description
Medtronic received information regarding a navigation system.It was reported outside of a procedure that the screw of the spine clamp was outworn.No patient was present at the time of the event.
Additional Manufacturer Narrative
The clamp was returned to the manufacture for evaluation.After functional testing and visual/physical examination the reported issue was not confirmed.The returned clamp is intact and fully functional per design.No problem found.If information is provided in the future, a supplemental report will be issued.

• Brand Name: SPINE CLAMP
• Common Device Name: ORTHOPEDIC STEREOTAXIC INSTRUMENT
• Manufacturer (Section D): MEDTRONIC NAVIGATION, INC; 826 coal creek circle; louisville CO 80027
• MDR Report Key: 9537929
• Report Number: 1723170-2020-00003
• Device Sequence Number: 2340787
• Product Code: OLO
• UDI-Device Identifier: 00763000205300
• UDI-Public: 00763000205300
• Combination Product (Y/N): N
• Initial Reporter Country: GM
• PMA/510(K) Number: K131425
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 04/22/2020

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: 9734715
• Device Catalogue Number: 9734715
• Device Lot Number: 181010
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 04/08/2020
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 12/12/2019
• Supplement Date Received by Manufacturer: 04/09/2020
• Initial Report FDA Received Date: 01/02/2020
• Supplement Report FDA Received Date: 04/22/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1