BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    O-ARM 1000 IMAGING SYSTEM 3RD EDITION

    MDR report key: 6079584 · Received November 4, 2016

    Report

    Report Number
    1723170-2016-05252
    Event Type
    Malfunction
    Date Received
    November 4, 2016
    Date of Event
    January 20, 2016
    Report Date
    November 4, 2016
    Manufacturer
    MEDTRONIC NAVIGATION, INC. (LITTLETON)
    Product Code
    OXO
    PMA / PMN Number
    K092564
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CO, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    NO PATIENT INFORMATION PROVIDED AS NO PATIENT WAS INVOLVED IN THIS CONCERN. A MEDTRONIC REPRESENTATIVE INSPECTED THE IMAGING SYSTEM ON-SITE. IT WAS CONFIRMED THAT THE IMAGING SYSTEM FAILS TO BOOT UP. REPLACED IMAGE ACQUISITION SYSTEM (IAS) COMPUTER. VERIFIED THAT THE SYSTEM FUNCTIONS PROPERLY AND IS ACCURATE WITH NAVIGATION. THE IAS COMPUTER WAS RECEIVED BY THE MANUFACTURER FOR EVALUATION. ANALYSIS CONFIRMED THE REPORTED COMPLAINT. FAILED BENCH TEST. AFTER SETTING IAS UP FOR BENCH TEST, TURNED ON THE POWER. ALL LIGHTS ON THE IAS WERE OPERATING CORRECTLY, CAN HEAR THE HARD DRIVE RUNNING BUT HAVE NO VIDEO OUTPUT. OPEN HOUSING CHECKING FOR LOOSE OR DISCONNECTED CONNECTIONS. ALL LOOK GOOD. REBOOT IAS NO VIDEO OUTPUT. AN ELECTRICAL FAILURE MODE WAS CONFIRMED WITH THE IAS COMPUTER. A FULL IMAGING SYSTEM CHECK-OUT WAS COMPLETED FOLLOWING COMPUTER REPLACEMENT AND ALL TESTS PASSED. FULL SYSTEM FUNCTIONALITY WAS CONFIRMED AND THE SYSTEM WAS RETURNED TO SERVICE. (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 REPORTED MALFUNCTION WAS NOT PREVIOUSLY ASSOCIATED WITH SERIOUS INJURIES. SIMILAR MALFUNCTIONS THAT HAD RESULTED IN SIGNIFICANT DELAYS OF SURGERY OR REQUIRED ADDITIONAL INTERVENTION HAD BEEN REPORTED AS MDR SERIOUS INJURIES. BASED ON THIS 483 OBSERVATION, THE REPORTING DETERMINATION HAS BEEN REVISED TO CONSIDER THESE MALFUNCTION EVENTS REPORTABLE. 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.

    Description of Event or Problem · 1

    A MEDTRONIC REPRESENTATIVE REPORTED THAT THE IMAGING SYSTEM DISPLAYED THE MESSAGE "SYSTEM BOOTING, PLEASE WAIT" DURING BOOT UP, AND WOULD NOT ADVANCE TO A READY STATE. THE SYSTEM WAS REBOOTED SEVERAL TIMES WITHOUT RESOLUTION. THE USER WAS UNABLE TO ACCESS THE IMAGE ACQUISITION SYSTEM (IAS) COMPUTER REMOTELY. THERE WAS NO PATIENT PRESENT WHEN THIS ISSUE WAS IDENTIFIED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    731831 O-ARM 1000 IMAGING SYSTEM 3RD EDITION IMAGE-INTENSIFIED FLUOROSCOPIC X-RAY SYSTEM, MOBILE OXO MEDTRONIC NAVIGATION, INC. (LITTLETON) BI-700-00028-120

    Patients

    Seq Age Sex Outcome Treatment
    1