BEUDAMED
    FDA Adverse Event Injury Summary report: N

    HAKIM INLINE PROGRAMMABLE VALVE SG

    MDR report key: 654789 · Received December 20, 2005

    Report

    Report Number
    1226348-2005-00298
    Event Type
    Injury
    Date Received
    December 20, 2005
    Date of Event
    November 23, 2005
    Manufacturer
    CODMAN & SHURTLEFF, INC/MEDOS S.A
    Product Code
    JXG
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WV, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    SALES REP REPORTS THAT DR EXPLANTED PRODUCT CODE 82-3162 BECAUSE HE SUSPECTS AN OCCLUSION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HAKIM INLINE PROGRAMMABLE VALVE SG SHUNT, CENTRAL NERVOUS SYSTEM & COMPS JXG CODMAN & SHURTLEFF, INC/MEDOS S.A NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR Required Intervention