inforMED
MalfunctionLWH

SITUATE

Received May 21, 2025 · Event occurred Apr 18, 2025

Report 1717344-2025-00659 · MDR key 22059393

Device

Generic name

Counter, Sponge, Surgical

Model number

01-0031

Catalog number

01-0031

Product problems

  • False Positive Result
  • False Positive Result

Patient

NA · Unknown

  • Insufficient Information
  • No Clinical Signs, Symptoms or Conditions
  • Insufficient Information
  • No Clinical Signs, Symptoms or Conditions

Narrative

Additional Manufacturer Narrative

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. MEDTRONIC WILL SUBMIT A SUPPLEMENTAL REPORT IF ADDITIONAL RELEVANT INFORMATION BECOMES KNOWN.

Description of Event or Problem

ACCORDING TO THE REPORTER THE BODY SCANNER ALERTED FOR A POTENTIAL SPONGE, BUT IT WAS CONFIRMED INCORRECT WHEN CHECKED WITH AN ALTERNATE CONSOLE WAND AND REAPPLICATION OF THE DEVICE.

Additional Manufacturer Narrative

ADDITIONAL INFORMATION: B3, B5, G3, H6. 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

ACCORDING TO THE REPORTER, AFTER PROCEDURE, THE BODY SCANNER ALERTED FOR A POTENTIAL SPONGE, BUT IT WAS CONFIRMED INCORRECT WHEN CHECKED WITH AN ALTERNATE CONSOLE WAND AND REAPPLICATION OF THE DEVICE. THERE WAS NO PATIENT INJURY.