BEUDAMED
    FDA Adverse Event Other Summary report: N

    CSF-SHUNT KIT, BURR HOLE VALVE, 16MM, MEDIUM

    MDR report key: 483465 · Received September 9, 2003

    Report

    Report Number
    2021898-2003-00128
    Event Type
    Other
    Date Received
    September 9, 2003
    Date of Event
    April 22, 2003
    Report Date
    August 11, 2003
    Manufacturer
    MEDTRONIC NEUROSURGERY
    Product Code
    JXG
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TH
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT DURING TESTING PRIOR TO SURGERY, THE PRODUCT DID NOT WORK.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CSF-SHUNT KIT, BURR HOLE VALVE, 16MM, MEDIUM CENTRAL NERVOUS SYSTEM FLUID SHUNTS AND COMPONENTS JXG MEDTRONIC NEUROSURGERY * A20394

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN