BEUDAMED
    FDA Adverse Event Death Summary report: N

    UNKNOWN PERITONEAL CATHETER

    MDR report key: 6434318 · Received March 24, 2017

    Report

    Report Number
    2021898-2017-00138
    Event Type
    Death
    Date Received
    March 24, 2017
    Date of Event
    October 31, 2016
    Report Date
    March 21, 2017
    Manufacturer
    MEDTRONIC NEUROSURGERY
    Product Code
    JXG
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AK, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

    Additional Manufacturer Narrative · 1

    IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

    Description of Event or Problem · 1

    IT WAS REPORTED TO MEDTRONIC NEUROSURGERY THAT THE DEVICE POSSIBLY FAILED. ACCORDING TO THE REPORT, THE PATIENT WAS DECEASED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    213917 UNKNOWN PERITONEAL CATHETER SHUNT, CENTRAL NERVOUS SYSTEM AND COMPONENTS JXG MEDTRONIC NEUROSURGERY UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 2 YR Death