BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CSF-CARDIAC/PERITONEAL CATHETER, STANDARD, 90CM

    MDR report key: 182435 · Received August 13, 1998

    Report

    Report Number
    2021898-1998-00073
    Event Type
    Injury
    Date Received
    August 13, 1998
    Date of Event
    March 26, 1996
    Report Date
    December 9, 1997
    Manufacturer
    MEDTRONIC PS MEDICAL
    Product Code
    JXG
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    A SEVEN YEAR-OLD PT HAS EXPERIENCED FOUR INSTANCES OF PERITONEAL CATHETER FRACTURE, JUST BELOW THE LEVEL OF THE SHUNT VALVE. (MEDWATCH REPORT NUMBERS 2021898-1998-00003,-00073,-00074,00075.)

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CSF-CARDIAC/PERITONEAL CATHETER, STANDARD, 90CM Implant CENTRAL NERVOUS SYSTEM FLUID SHUNTS AND COMPONENTS JXG MEDTRONIC PS MEDICAL NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 6 YR Required Intervention