FDA Adverse Event Malfunction Summary report: N

STEALTHSTATION IOR SYSTEM

MDR report key: 4277584 · Received November 25, 2014

Report

Report Number
1723170-2014-01281
Event Type
Malfunction
Date Received
November 25, 2014
Date of Event
October 31, 2014
Report Date
October 31, 2014
Manufacturer
MEDTRONIC NAVIGATION, INC.
Product Code
HAW
PMA / PMN Number
K050438
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
IN
Reporter Occupation
MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

Narratives

Additional Manufacturer Narrative · 1

PATIENT INFORMATION WAS NOT MADE AVAILABLE FROM THE SITE. NO PARTS HAVE BEEN RETURNED TO MANUFACTURER FOR ANALYSIS.

Additional Manufacturer Narrative · 1

A MEDTRONIC REPRESENTATIVE REPORTED THAT THE TOOL INTERFACE UNIT (TIU) WAS REPLACED ON 12/09/2014 AND THE SYSTEM WAS WORKING FINE. NO PARTS HAVE BEEN RETURNED TO THE MANUFACTURER FOR ANALYSIS.

Description of Event or Problem · 1

A MEDTRONIC REPRESENTATIVE REPORTED A SITE NAVIGATION SYSTEM CAMERA THAT WAS DISPLAYING BLACK STATUS INTERMITTENTLY. NO FURTHER DETAILS REGARDING THE DAMAGE, OR HOW IT OCCURRED, WERE PROVIDED. THERE WAS NO PATIENT PRESENT WHEN THIS ISSUE WAS IDENTIFIED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
763993 STEALTHSTATION IOR SYSTEM NEUROLOGICAL STEREOTAXIC INSTRUMENT HAW MEDTRONIC NAVIGATION, INC. IOR

Patients

Seq Age Sex Outcome Treatment
1