MAUDE Adverse Event Report: CHRISTOPH MIETHKE GMBH & CO KG MININAV SET PED.5 W.BURRHOLE RESERVOIR; HYDROCEPHALUS MANAGEMENT

Model Number	FV683T
Medical Device Problem Code	Infusion or Flow Problem (2964)
Health Effect - Clinical Code	Hydrocephalus (3272)
Date of Event	11/24/2020
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Investigation: visual inspection: no significant deformations or damage of the valve were detected during the visual inspection.Residues tissues are visible outside the product.Permeability test: a permeability test has shown that the valve is permeable.During the test, particles were flushed out.Computer controlled test: to investigate the clinical claim of under-drainage, the opening pressure is measured using a miethke computer controlled testing apparatus which simulates a cerebrospinal fluid flow.The mininav is not operating within acceptable tolerances.Result : first, we performed a visual inspection of the mininav.No significant deformations or damage of the valve were detected during the visual inspection.Next, we tested the permeability and opening pressure of the valve.The opening pressure of the valve was out of tolerance, but all other specifications were met.The opening pressure of the valve was significantly higher than expected, shows a slower flow of liquid.Finally, we have dismantled the valve.Inside the valve we have found a build-up of substances (likely protein).Based on our investigation, we confirm that the valve shows a slower flow of liquid 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 valve 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 mininav.The surgeon suspected a clinical symptomatic of underdrainage.Patient informations: age: (b)(6), weight: unknown, height: unknown, gender: female, date of implantation: (b)(6) 2020, date of removal: (b)(6) 2020.

• Brand Name: MININAV SET PED.5 W.BURRHOLE RESERVOIR
• Common Device Name: HYDROCEPHALUS MANAGEMENT
• Manufacturer (Section D): CHRISTOPH MIETHKE GMBH & CO KG; ulanenweg 2; potsdam, 14469 ; GM 14469
• MDR Report Key: 11013599
• Report Number: 3004721439-2020-00255
• Device Sequence Number: 4495952
• Product Code: JXG
• UDI-Device Identifier: 04041906133863
• UDI-Public: 4041906133863
• Combination Product (Y/N): N
• Initial Reporter Country: GM
• PMA/510(K) Number: K110206
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2020
• Device Explanted Year: 2020
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,user f
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 12/07/2020

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: 01/08/2025
• Device Model Number: FV683T
• Device Catalogue Number: FV683T
• Device Lot Number: 20045505
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 11/26/2020
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 11/26/2020
• Initial Report FDA Received Date: 12/15/2020
• 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: 7 MO