O-ARM 1000 IMAGING SYSTEM
Report
- Report Number
- 1723170-2016-01691
- Event Type
- Malfunction
- Date Received
- August 3, 2016
- Date of Event
- August 27, 2014
- Report Date
- August 3, 2016
- Manufacturer
- MEDTRONIC NAVIGATION, INC. (LITTLETON)
- Product Code
- OXO
- PMA / PMN Number
- K050996
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- MO, US
- Reporter Occupation
- OTHER HEALTH CARE PROFESSIONAL
Narratives
A MEDTRONIC REPRESENTATIVE VISITED THE SITE TO EXAMINE THE MEDTRONIC IMAGING SYSTEM, RESULTING IN THE DECISION TO RETRIEVE LOG FILES AND RETURN THEM TO THE MANUFACTURER FOR ANALYSIS SINCE THE ORIGINAL ISSUE COULD NOT BE REPLICATED IN SITU. AFTER OFFLOADING THE FILES, THE REPRESENTATIVE PERFORMED AN IMAGING SYSTEM CHECK-OUT AND TESTED AREAS PASSED. SYSTEM PERFORMED AS INTENDED. THE SOFTWARE INVESTIGATION FOUND THAT THE REPORTED EVENT WAS RELATED TO A SOFTWARE ISSUE. THIS ISSUE WAS DOCUMENTED IN A MEDTRONIC NAVIGATION SOFTWARE ANOMALY TRACKING DATABASE. THIS EVENT WAS IDENTIFIED DURING A RETROSPECTIVE REVIEW AS DISCUSSED WITH THE FDA (B)(4) DISTRICT OFFICE ON APRIL 7, 2016 VIA MEDTRONIC NAVIGATION, INC. RESPONSE TO 3/17/2016 (B)(4). THIS REVIEW WAS PERFORMED AS A RESULT OF RECENT CHANGES/IMPROVEMENTS TO THE MEDTRONIC NAVIGATION, INC. MEDICAL DEVICE REPORT (MDR) REVIEW PROCESS AND IS FOR NON-ADVERSE EVENT REPORTABLE MALFUNCTIONS WITHIN THE LAST TWO YEARS WHERE THE USE OF THE O-ARM IMAGING SYSTEM WAS ABORTED. THIS PROCESS CHANGE RESULTED IN AN OVERALL INCREASE IN THE NUMBER OF MDRS FILED BY MEDTRONIC NAVIGATION, INC., SINCE APRIL 2016. IT SHOULD BE NOTED THAT THIS INCREASE IS NOT THE RESULT OF THE DISCOVERY OF NEW PRODUCT PROBLEMS, BUT RATHER THE RESULT OF A BROADER INTERPRETATION AND APPLICATION OF THE REGULATIONS WITHIN OUR PROCESSES.
A SITE REPRESENTATIVE REPORTED THAT, WHILE IN A SPINAL FUSION PROCEDURE, THE MEDTRONIC IMAGING SYSTEM WAS UNABLE TO TRANSFER IMAGES TO THE MEDTRONIC NAVIGATION SYSTEM. SWAPPING THE NETWORK CABLE DID NOT RESOLVE THE ISSUE. THE SURGEON DECIDED TO ABORT THE USE OF THE MEDTRONIC IMAGING AND NAVIGATION SYSTEM. THERE WAS A REPORTED DELAY TO THE PROCEDURE OF LESS THAN 1 HOUR DUE TO THIS ISSUE. THERE WAS NO IMPACT ON PATIENT OUTCOME.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 495439 | O-ARM 1000 IMAGING SYSTEM | IMAGE-INTENSIFIED FLUOROSCOPIC X-RAY SYSTEM, MOBILE | OXO | MEDTRONIC NAVIGATION, INC. (LITTLETON) | BI-700-00027-120 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 55 YR |