BEUDAMED
    FDA Adverse Event Injury Summary report: N

    STD PV W/ PRECHAMBER, HIGH

    MDR report key: 677811 · Received February 21, 2006

    Report

    Report Number
    1226348-2006-00017
    Event Type
    Injury
    Date Received
    February 21, 2006
    Date of Event
    January 24, 2006
    Manufacturer
    CODMAN & SHURTLEFF, INC/MEDOS S.A.
    Product Code
    JXG
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    UK
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE AFFILIATE REPORTS THAT THE PATIENT WAS SYMPTOMATIC, SUFFERING FROM HEADACHES. THE SURGEON REMOVED THE VALVE BECAUSE HE SUSPECTED A BLOCKAGE. THE PATIENT IS IN GOOD CONDITION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 STD PV W/ PRECHAMBER, HIGH CENTRAL NERVOUS SYSTEM & COMPONENTS JXG CODMAN & SHURTLEFF, INC/MEDOS S.A. NA 1010103

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Required Intervention