BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MCGRATH

    MDR report key: 21526231 · Received March 5, 2025

    Report

    Report Number
    3010244187-2025-00501
    Event Type
    Malfunction
    Date Received
    March 5, 2025
    Date of Event
    October 2, 2023
    Report Date
    March 17, 2026
    Manufacturer
    AIRCRAFT MEDICAL LIMITED
    Product Code
    CCW
    UDI-DI
    15060272980068
    PMA / PMN Number
    EXEMPT
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    OTHER
    Health Professional
    N

    Narratives

    Additional Manufacturer Narrative · 0

    THIS REGULATORY REPORT IS BEING SUBMITTED DUE TO RETROSPECTIVE REVIEW THROUGH CAPA: 624392. D10 CONCOMITANT PRODUCT: 340-000-000, MCGRATH 3.6V BATTERY 340-000-000 (LOT#: 8068505); 340-000-000, MCGRATH 3.6V BATTERY 340-000-000 (LOT#: H21082004); 340-000-000, MCGRATH 3.6V BATTERY 340-000-000 (LOT#: H22081904); 340-000-000, MCGRATH 3.6V BATTERY 340-000-000 (LOT#: H22042504); 340-000-000, MCGRATH 3.6V BATTERY 340-000-000 (LOT#: H20121404); 340-000-000, MCGRATH 3.6V BATTERY 340-000-000 (LOT#: H21091104). MEDTRONIC SUBMITS THIS REPORT TO COMPLY WITH FDA REGULATIONS 21 CFR PARTS 4 AND 803. MEDTRONIC HAS MADE REASONABLE EFFORTS TO PROVIDE AS MUCH RELEVANT INFORMATION AS IS AVAILABLE TO THE COMPANY AS OF THE SUBMISSION DATE OF THIS REPORT. THIS REPORT DOES NOT CONSTITUTE AN ADMISSION OR A CONCLUSION BY FDA, MEDTRONIC, OR ITS EMPLOYEES THAT THE DEVICE, MEDTRONIC, OR ITS EMPLOYEE CAUSED OR CONTRIBUTED TO THE EVENT DESCRIBED IN THE REPORT. ANY REQUIRED FIELDS THAT ARE UNPOPULATED ARE BLANK BECAUSE THE INFORMATION IS CURRENTLY UNKNOWN OR UNAVAILABLE. MEDTRONIC WILL SUBMIT A SUPPLEMENTAL REPORT IF ADDITIONAL RELEVANT INFORMATION BECOMES KNOWN.

    Additional Manufacturer Narrative · 0

    ADDITIONAL INFORMATION: D9, G3, H3, H6. H3 EVALUATION SUMMARY: MEDTRONIC CONDUCTED AN INVESTIGATION BASED UPON ALL INFORMATION RECEIVED. THE DEVICE WAS AVAILABLE FOR EVALUATION. THE BATTERY WAS T ESTED, THE AND THE ISSUE WAS REPLICATED. THE BATTERY DID NOT POWER ON THE DEVICE. BOTH THE DISPLAY AND THE LED DID NOT WORK WHEN THE BATTERY WAS IN THE DEVICE. AFTER APPLYING FORCE TO THE MIDDLE PART OF THE BATTERY, THE DEVICE WOULD TURN ON. IT WAS REPORTED THAT V IDEOLARYNGOSCOPE SHOWED FOUR SMALL SQUARES, AND THE SCREEN DID NOT APPEAR OR TURN ON WHEN THE BATTERY IN QUESTION WAS USED. THE REPORTED ISSUE WAS CONFIRMED. THE MOST LIKELY CAUSE WAS TRACED TO COMPONENT FAILURE. THE MANUFACTURING RECORDS FOR EACH DEVICE ARE THOROUGHLY REVIEWED PRIOR TO RELEASE TO ENSURE THAT IT MEETS ALL MEDTRONIC QUALITY SPECIFICATIONS. MEDTRONIC SUBMITS THIS REPORT TO COMPLY WITH FDA REGULATIONS 21 CFR PARTS 4 AND 803. MEDTRONIC HAS MADE REASONABLE EFFORTS TO PROVIDE AS MUCH RELEVANT INFORMATION AS IS AVAILABLE TO THE COMPANY AS OF THE SUBMISSION DATE OF THIS REPORT. THIS REPORT DOES NOT CONSTITUTE AN ADMISSION OR A CONCLUSION BY FDA, MEDTRONIC, OR ITS EMPLOYEES THAT THE DEVICE, MEDTRONIC, OR ITS EMPLOYEE CAUSED OR CONTRIBUTED TO THE EVENT DESCRIBED IN THE REPORT. ANY REQUIRED FIELDS THAT ARE UNPOPULATED ARE BLANK BECAUSE THE INFORMATION IS CURRENTLY UNKNOWN OR UNAVAILABLE. MEDTRONIC WILL SUBMIT A SUPPLEMENTAL REPORT IF ADDITIONAL RELEVANT INFORMATION BECOMES KNOWN.

    Description of Event or Problem · 0

    ACCORDING TO THE REPORTER, THE VIDEOLARYNGOSCOPE SHOWED FOUR SMALL SQUARES, AND THE SCREEN DID NOT APPEAR OR TURN ON WHEN THE BATTERY IN QUESTION WAS USED. THE BATTERY WAS REPLACED AND THE HANDLE WAS POWER CYCLED, BUT THE ISSUE REMAINED. THERE WAS NO PATIENT INVOLVEMENT. THE SIX ADDITIONAL BATTERIES SHOWED THE SAME FAILURE, AND IT WAS UNKNOWN IF THERE WAS PATIENT INVOLVEMENT AT THE TIME OF THE REPORTED EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    610683 MCGRATH LARYNGOSCOPE, RIGID CCW AIRCRAFT MEDICAL LIMITED 340-000-000 H21082004 15060272980068

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Unknown PLEASE SEE NOTE ON H11.