MAUDE Adverse Event Report: INTEGRA LIFESCIENCES SWITZERLAND SAR CERTAS INLINE VLV ONLY; CERTAS PLUS

Model Number	82-8800PL
Medical Device Problem Code	Obstruction of Flow (2423)
Health Effect - Clinical Code	Balance Problems (4401)
Date of Event	02/08/2022
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
An investigation has been initiated based on the reported information.Upon completion of the investigation, a follow-up report will be submitted.
Event or Problem Description
A physician reported a certas valve (id 828800) was implanted in a (b)(6) female patient via "l-p" shunt on (b)(6) 2021 with setting 2.The valve was used with the silascon lumbar catheter (manufactured by kaneka, product code: 702-jj).A shunt dysfunction was suspected and shunt contrast examination confirmed a proximal obstruction on (b)(6) 2022.The patient had repeated falls and it is unknown if the patient experienced any signs and symptoms.The valve and the lumbar catheter were removed on (b)(6).The valve was replaced on (b)(6).The patient recovered.
Additional Manufacturer Narrative
Updated fields:  b3, d4, d6b, d9, g3, g6, h2, h3, h6, h10.The certas valve was returned for evaluation: failure analysis - the position of the cam when valve was received was at setting 2.The valve was visually inspected; no defects were noted.The valve was hydrated.The catheter was irrigated no occlusion noted.The valve was leak tested and no leaks noted.The valve passed the test for programming, occlusion, reflux, siphon guard and pressure.No root cause could be determined as the technician could not confirm any problem with the valve at the time of investigation.The possible root cause for the issue reported by the customer could be due to biological debris and protein build up interfering with the valve mechanism, but at the time of investigation no occlusion issues were noted.Additional information received: incident date/ valve replacement: february 8, 2022.

• Brand Name: CERTAS INLINE VLV ONLY
• Common Device Name: CERTAS PLUS
• Manufacturer (Section D): INTEGRA LIFESCIENCES SWITZERLAND SAR; rue girardet 29; rue girardet 29; le locle ; SZ
• Manufacturer (Section G): INTEGRA LIFESCIENCES SWITZERLAND SAR; rue girardet 29; ch-2400; le locle ; SZ
• Manufacturer Contact: vivian nelson ; 1100 campus drive; princeton, NJ ; 6099362319
• MDR Report Key: 13636305
• Report Number: 3013886523-2022-00063
• Device Sequence Number: 14000019
• Product Code: JXG
• UDI-Device Identifier: 10886704079002
• UDI-Public: 10886704079002
• Combination Product (Y/N): N
• PMA/510(K) Number: K143111
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2021
• Device Explanted Year: 2022
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,User Facility
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 04/12/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: No
• Operator of Device: Health Professional
• Device Model Number: 82-8800PL
• Device Catalogue Number: 828800
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 02/10/2022
• Supplement Date Received by Manufacturer: 03/28/2022
• Initial Report FDA Received Date: 03/01/2022
• Supplement Report FDA Received Date: 04/12/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Patient Age: 77 YR
• Patient Sex: Female