BEUDAMED
    FDA Adverse Event Other Summary report: N

    CSF-UNITIZED SHUNT KIT, REGULAR, MEDIUM PRESSURE

    MDR report key: 483460 · Received September 9, 2003

    Report

    Report Number
    2021898-2003-00127
    Event Type
    Other
    Date Received
    September 9, 2003
    Date of Event
    August 7, 2003
    Report Date
    August 13, 2003
    Manufacturer
    MEDTRONIC NEUROSURGERY
    Product Code
    JXG
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE VENTRICULAR SEGMENT BROKE OFF AT 2 CM FROM THE END WHEN THE PHYSICIAN TRIED TO SLIDE THE RIGHT ANGLE CLIP AT SETUP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CSF-UNITIZED SHUNT KIT, REGULAR, MEDIUM PRESSURE CENTRAL NERVOUS SYSTEM FLUID SHUNTS AND COMPONENTS JXG MEDTRONIC NEUROSURGERY * Y9946

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN