BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SOPHYSA VP SHUNT

    MDR report key: 723796 · Received May 17, 2006

    Report

    Report Number
    MW1039244
    Event Type
    Injury
    Date Received
    May 17, 2006
    Date of Event
    March 2, 2006
    Report Date
    April 3, 2006
    Manufacturer
    *
    Product Code
    JXG
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    FL, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    REMOVAL SOPHYSA VP SHUNT DUE TO MALFUNCTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SOPHYSA VP SHUNT VP SHUNT JXG * 5M8 B-2010 M0412

    Patients

    Seq Age Sex Outcome Treatment
    1 81 YR Required Intervention