BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CODMAN VENTRICULAR DRAIN

    MDR report key: 2163519 · Received July 7, 2011

    Report

    Report Number
    MW5021300
    Event Type
    Injury
    Date Received
    July 7, 2011
    Date of Event
    June 13, 2011
    Report Date
    July 7, 2011
    Manufacturer
    JOHNSON & JOHNSON
    Product Code
    JXG
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NE, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    A CODMAN VENTRICULAR DRAIN TUBING THAT IS MOLDED NEXT TO THE STOPCOCK SEPARATED AND EXPOSED THE TUBING ATTACHED TO THE LUMBAR DRAIN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CODMAN VENTRICULAR DRAIN VENTRICULAR DRAIN JXG JOHNSON & JOHNSON UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 57 YR Disability NONE OTHER THAN PREVIOUSLY IDENTIFIED.