MAUDE Adverse Event Report: CHRISTOPH MIETHKE GMBH & CO. KG PROGAV SYS M.SA 15 U.CONTROL RESERVOIR; HYDROCEPHALUS MANAGEMENT

Model Number	FV433T
Medical Device Problem Codes	Mechanical Problem (1384); Infusion or Flow Problem (2964)
Health Effect - Clinical Code	Hydrocephalus (3272)
Date of Event	11/19/2020
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Visual inspection: no significant deformations or damage of the valves were detected during the visual inspection.Permeability test: a permeability test has shown that both valves are permeable.Adjustment test: the progav® was tested and is not adjustable throughout the normal range.Braking force and brake function test the brake functionality test has shown tha:t the brake function is operational, however the braking force cannot be measured due to the non-adjustability of the valve.Computer controlled test: to investigate the clinical claim of over, the opening pressure is measured using a miethke computer controlled testing apparatus which simulates a cerebrospinal fluid flow.The progav® valve operates within the accepted tolerance, but the shuntassistant® is slightly underdrained.Results: first, we performed a visual inspection of the progav® shunt system.No significant deformations or damage of the valves were detected during the visual inspection.Next, we tested the permeability and opening pressure of the valves.Both valves were shown to be permeable.The opening pressure of the shuntassistant® was significantly higher than expected, indicating a tendency towards under-drainage.Additionally, we tested the adjustability as well as the brake functionality and brake force of the progav® valve.The valve was not adjustable to all settings.The brake functionality was fully operational, however due to the inability of the valve to hold a set pressure, it was not possible to measure the brake force.Finally, we have dismantled the valves.Inside both valves we have found slight build-up of substances (likely protein) based on our investigation, we confirm that the valve was non-adjustable at the time of our investigation.This is likely due to the deposits observed inside the valves.As described in scientific literature, the problem encountered is one of the known, inevitable risks of hc-therapy by shunt implants.We can exclude a defect at the time of release.The shunt system met all specifications of the final inspection when released from christoph miethke (b)(4).No further regulatory actions are required from our point of view.
Event or Problem Description
It was reported that there was a problem with a prosa shunt system.The surgeon replaced the shunt system due to suspected overdrainage and adjustment problems.Patient informations: age: (b)(6) years.Height: 150 cm.Weight: (b)(6) kg.Implantation: (b)(6) 2009.Removal: (b)(6) 2020.

• Brand Name: PROGAV SYS M.SA 15 U.CONTROL RESERVOIR
• Common Device Name: HYDROCEPHALUS MANAGEMENT
• Manufacturer (Section D): CHRISTOPH MIETHKE GMBH & CO. KG; ulanenweg 2; potsdam, 14469 ; GM 14469
• MDR Report Key: 10983135
• Report Number: 3004721439-2020-00254
• Device Sequence Number: 16319232
• Product Code: JXG
• UDI-Device Identifier: 04041906132453
• UDI-Public: 04041906132453
• Combination Product (Y/N): Y
• Initial Reporter Country: GM
• PMA/510(K) Number: K103003
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2009
• Device Explanted Year: 2019
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: company representative,user f
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 12/08/2020

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
• Operator of Device: Health Professional
• Device Expiration Date: 12/12/2012
• Device Model Number: FV433T
• Device Catalogue Number: FV433T
• Device Lot Number: 20007220
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 11/24/2020
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 11/24/2020
• Initial Report FDA Received Date: 12/10/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 11 YR
• Patient Weight: 55