FDA Adverse Event Injury Summary report: N

UNKNOWN VALVE/SHUNT

MDR report key: 6648366 · Received June 16, 2017

Report

Report Number
2021898-2017-00330
Event Type
Injury
Date Received
June 16, 2017
Report Date
May 19, 2017
Manufacturer
MEDTRONIC NEUROSURGERY
Product Code
JXG
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
SP
Reporter Occupation
PATIENT

Narratives

Additional Manufacturer Narrative · 1

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

Additional Manufacturer Narrative · 1

ADDITIONAL INFORMATION RECEIVED REPORTED THE PATIENT ONLY HAD ONE VALVE EXPLANTED, NOT TWO. THIS MANUFACTURER REPORT ORIGINALLY REPRESENTED A SECOND VALVE OF THE PATIENT, WHEREAS THE OTHER VALVE WAS CAPTURED IN MANUFACTURER REPORT #2021898-2017-00327. PLEASE REFERENCE THIS REPORT FOR INFORMATION REGARDING THE ISSUES EXPERIENCED WITH THEIR EXPLANTED VALVE. IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

Additional Manufacturer Narrative · 1

ADDITIONAL INFORMATION RECEIVED REPORTED THE PATIENT ONLY HAD ONE VALVE EXPLANTED, NOT TWO. THIS MANUFACTURER REPORT ORIGINALLY REPRESENTED A SECOND VALVE OF THE PATIENT, WHEREAS THE OTHER VALVE WAS CAPTURED IN MANUFACTURER REPORT #2021898-2017-00327. PLEASE REFERENCE THIS REPORT FOR INFORMATION REGARDING THE ISSUES EXPERIENCED WITH THEIR EXPLANTED VALVE. 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 PATIENT DEVELOPED AN INFECTION. ACCORDING TO THE REPORT, THE VALVE WAS REPLACED. REPORTEDLY, THE PATIENT'S STATUS WAS ALIVE-NO INJURY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
429237 UNKNOWN VALVE/SHUNT SHUNT, CENTRAL NERVOUS SYSTEM AND COMPONENTS JXG MEDTRONIC NEUROSURGERY UNKNOWN

Patients

Seq Age Sex Outcome Treatment
1 Hospitalization| R