FDA Adverse Event Death Summary report: N

HOLTER VALVE (VENTRICULO-PERITONEAL SHUN)

MDR report key: 28084 · Received December 3, 1993

Report

Report Number
28084
Event Type
Death
Date Received
December 3, 1993
Date of Event
April 20, 1993
Report Date
November 30, 1993
Manufacturer
CODMAN & SHURFTLEFF-JOHNSON & JOHNSON
Product Code
LXL
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

44 YR OLD MALE UNDERWENT PLACEMENT OF BIVENTRICULO-PERITONEAL SHUNT FOR A PREVIOUSLY REMOVED VENTRICULAR HEMORRHAGIC COLLIOD CYST. A MEDIUM PRESSURE HHOLTER SHUNT VALVE WAS USED AND TESTED BEFORE AND AFTER PLACEMENT WITH FINDING THAT "A COLUMN OF SALINE FELL AT A MODERATE RATE AND THERE WAS A GOOD FLOW OF FLUID FROM PERITONEAL END OF ASSEMBLY." RETURNED TO SURGERY 4/27/93 FOR REVISION. CT SCAN SHOWED LESS IMPROVEMENT IN VENTRICULAR SIZE THAN EXPECTED. VALVED SILASTIC KNITTING IDENTIFIED AS PROBLEM. REPLACED WITH LOW PRESSURE HOLTER VALVE. MRI REVEALED GLIOBLASTOMA. PT DEVELOPED ASPITARION PNEUMONIA AND EXPIRED 6/16/93.INVALID DATA - REGARDING SINGLE USE LABELING OF DEVICE. PATIENT MEDICAL STATUS PRIOR TO EVENT: UNKNOWN. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY.NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.INVALID DATA - REGARDING EVALUATION BY USER AFTER EVENT. METHOD OF EVALUATION: INVALID DATA. RESULTS OF EVALUATION: INVALID DATA. CONCLUSION: INVALID DATA. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: YES. CORRECTIVE ACTIONS: NONE OR UNKNOWN. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 HOLTER VALVE (VENTRICULO-PERITONEAL SHUN) LXL CODMAN & SHURFTLEFF-JOHNSON & JOHNSON

Patients

Seq Age Sex Outcome Treatment
1 44 YR Death