BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CHPV CYL W/LG RR NU120CM DIST

    MDR report key: 1893006 · Received October 28, 2010

    Report

    Report Number
    1226348-2010-00349
    Event Type
    Injury
    Date Received
    October 28, 2010
    Manufacturer
    CODMAN & SHURTLEFF, INC. MEDOS S.A.
    Product Code
    JXG
    PMA / PMN Number
    K974739
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    UPON COMPLETION OF THE INVESTIGATION, A FOLLOW UP REPORT WILL BE FILED.

    Description of Event or Problem · 1

    SALES REP REPORTED THAT: "VALVE WAS REVISED". NO OTHER DETAILS WERE AVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CHPV CYL W/LG RR NU120CM DIST SHUNT, CENTRAL NERVOUS SYSTEM & COMPS JXG CODMAN & SHURTLEFF, INC. MEDOS S.A. NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK