MAUDE Adverse Event Report: CHRISTOPH MIETHKE GMBH & CO KG M.BLUE 5 SYS W/PED.BURRHOLE RESERVOIR; HYDROCEPHALUS MANAGEMENT

Model Number FX846T

Device Problem Mechanical Problem (1384)

Patient Problem Hydrocephalus (3272)

Event Date 09/18/2023

Event Type  Injury  

Event Description

It was reported that a m.Blue (#fx846t) was implanted during a procedure performed on (b)(6) 2022.According to the complainant, the shunt system had adjustment difficulties.The patient underwent a revision procedure.The complainant device was returned to the manufacturer for evaluation.No patient complications were reported as a result of the revision procedure.Age: 81 years.Height: 188 cm.Weight: 77 kg.

Manufacturer Narrative

Investigation: visual inspection: during the investigation, scratches on the outer housing of the valve, but no significant deformation or damage was determined.Permeability test: a permeability test has indicated that the valve has a blockage.Computer control test: because the valve is not permeable, a computer control test is not applicable.Adjustment test: the m.Blue was tested and is not adjustable.Braking force and brake function test: the brake functionality test has shown that the brake function is operational.The braking force cannot be measured due to the non-adjustability of the valve.Internal inspection : after dismantling of the valve, deposits were found inside.Result : based on our investigation results, we can determine a blockage and a non- adjustability at the valve.The determined deposits can be named as the cause for the functional deviations.Organic deposits in the cerebrospinal fluid can influence the function temporarily and are known side effects in hydrocephalus therapy.We can exclude a defect at the time of release.The valve met all specifications of the final inspection when released from christoph miethke gmbh & co.Kg.No further regulatory actions are required from our point of view.

• Brand Name: M.BLUE 5 SYS W/PED.BURRHOLE RESERVOIR
• Type of Device: HYDROCEPHALUS MANAGEMENT
• Manufacturer (Section D): CHRISTOPH MIETHKE GMBH & CO KG; ulanenweg 2; potsdam, 14469 ; GM 14469
• Manufacturer (Section G): CHRISTOPH MIETHKE GMBH & CO KG; ulanenweg 2; potsdam, 14469 ; GM 14469
• Manufacturer Contact: joerg knebel ; ulanenweg 2; potsdam, 14469 ; GM 14469
• MDR Report Key: 18172808
• MDR Text Key: 328560032
• Report Number: 3004721439-2023-00352
• Device Sequence Number: 1
• Product Code: JXG
• UDI-Device Identifier: 04041906504762
• UDI-Public: 4041906504762
• Combination Product (y/n): N
• Reporter Country Code: NL
• PMA/PMN Number: K192266
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,User Facility,Company Representative
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date: 11/20/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: FX846T
• Device Catalogue Number: FX846T
• Device Lot Number: 20060970
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 11/02/2023
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 11/02/2023
• Initial Date FDA Received: 11/20/2023
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 08/22/2022
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 81 YR
• Patient Weight: 77 KG