FDA Adverse Event Other Summary report: N

POLARIS (R) ADJUSTABLE PRESSURE VALVE SHUNT

MDR report key: 641410 · Received October 13, 2005

Report

Report Number
3001587388-2005-00026
Event Type
Other
Date Received
October 13, 2005
Date of Event
August 30, 2005
Report Date
October 13, 2005
Manufacturer
SOPHYSA SA
Product Code
JXG
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
JA
Reporter Occupation
PHYSICIAN

Narratives

Description of Event or Problem · 1

THIS POLARIS ADJUSTABLE PRESSURE VALVE SPV WAS IMPLANTED TO A PATIENT WITH A PRESSURE ADJUSTED TO 30MM H20. SINCE THE PATIENT PRESENTED SHRINKING OF VENTRICLES, THE DOCTOR CHANGED THE PRESSURE OF THE SPV TO 70MMH20 ON JULY 6 AND RAISED IT GRADUALLY TO 200MMH20. THEN, HE REVISED THE VALVE WITH SM8 ON SEPTEMBER 1.

Description of Event or Problem · 1

THIS POLARIS ADJUSTABLE PRESSURE VALVE SPV WAS IMPLANTED TO A PT WITH A PRESSURE ADJUSTED TO 30 MMH2O. SINCE THE PT PRESENTED SHRINKING OF VENTRICLES, THE DR CHANGED THE PRESSURE OF THE SPV TO 70 MMH2O AND RAISED IT GRADUALLY TO 200 MMH2O. THEN, HE REVISED THE VALVE WITH SM8 IN 2005.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 POLARIS (R) ADJUSTABLE PRESSURE VALVE SHUNT SHUNT, CENTRAL NERVOUS SYSTEM & COMPONENTS JXG SOPHYSA SA POLARIS (R) VALVE P0384

Patients

Seq Age Sex Outcome Treatment
1 UNKNOWN Other