SITUATE
Received Jul 6, 2026 · Event occurred Jun 8, 2026
Report 3026612481-2026-00040 · MDR key 25728046
Device
Generic name
Gauze/sponge, Internal, X-ray Detectable
Manufacturer
CovidienModel number
G0404-16P01C-1Catalog number
G0404-16P01C-1
Lot number
250201AT
Product problems
- False Negative Result
- Detachment of Device or Device Component
Patient
Male
- 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. 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
IT WAS REPORTED THAT DURING PROCEDURE, THE RF TAG CAME OUT OF THE RAY TECH AND INTO THE PATIENT. THEY SCANNED THE PATIENT AND IT CAME UP CLEAR WITH THE CHIP BEING IN THE PATIENT. THE CHIP WAS FULLY RETRIEVED WITHOUT THE USE OF AN X-RAY. THERE WAS NO PATIENT HARM/INJURY.