BEUDAMED
    FDA Adverse Event Other Summary report: N

    PRODUCT IDENTITY: STRATA, ADJUSTABLE DELTA VALVE,

    MDR report key: 485115 · Received September 19, 2003

    Report

    Report Number
    2021898-2003-00137
    Event Type
    Other
    Date Received
    September 19, 2003
    Date of Event
    September 9, 2003
    Report Date
    September 9, 2003
    Manufacturer
    MEDTRONIC NEUROSURGERY
    Product Code
    JXG
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    VALVE BROKE AT THE SEAMS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PRODUCT IDENTITY: STRATA, ADJUSTABLE DELTA VALVE, CENTRAL NERVOUS SYSTEM FLUID SHUNTS AND COMPONENTS JXG MEDTRONIC NEUROSURGERY * A34779

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN