MAUDE Adverse Event Report: CHRISTOPH MIETHKE GMBH & CO KG PROGAV SYSTEM M.SA 10 U.SPRUNG RES.; HYDROCEPHALUS MANAGEMENT

Model Number	FV425T
Medical Device Problem Code	Infusion or Flow Problem (2964)
Health Effect - Clinical Code	Hydrocephalus (3272)
Date of Event	03/28/2022
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Manufacturing site evaluation: investigation on-going.Should relevant additional information / investigation results become available, a supplemental medwatch report will be submitted.
Event or Problem Description
It was reported that a progav shuntsystem (part # fv425t) was implanted during a procedure performed on an unknown date.According to the complainant, the physician suspected a drainage issue.The patient underwent a revision procedure on an unknown date.The complaint device has not been returned to the manufacturer for evaluation.No patient complications were reported as a result of the revision procedure.
Event or Problem Description
Patient details: age: 56 years.Weight: 75 kilograms (kg).Height: 173 centimeters (cm).Gender: unknown.
Additional Manufacturer Narrative
Investigation: visual inspection: the following observations were made during the visual inspection: - slightly visible deformation.- coloured distal catheter.Measurement of surface of the housing: no deformation detected, measured value: -0,002 mm [tolerance (0 ± 0.02mm)].Permeability test: the test showed that the progav shunt system is non-permeable.To determine the location of the occlusion, the shunt system was dismantled and each element was tested individually for permeability.The test showed that the peritoneal catheter is difficult permeable, while the progav shunt system without the catheter is permeable.Computer control test: the computer controlled test showed the opening pressure of the progav, at a reference flow rate of 20 ml/h in a horizontal position of the valve, to be 9,02 cmh2o.This is within the specified tolerance of 10 cmh2o ± 3 cmh2o.Additionally, the paedishuntassistant was tested according to standard procedure in the vertical position of the valve.At a fixed opening pressure of 10 cmh2o in the vertical position, a pressure of 10 cmh2o +4/-2 cmh2o is expected.The results indicated that at a reference flow of 20 ml/h in the vertical position, the paedishuntassistant had a pressure of 6,34 cmh2o.This is not within the specified tolerance of 10 cmh2o +4/-2 cmh2o.According to our results, we can detect a presence of an accelerated outflow.Adjustability test: the progav was found to be not adjustable to specifications.The paedishuntassistant is a fixed pressure valve, therefore the adjustability test is inapplicable.Braking force and brake function test: the braking force test indicates that the brake function of the progav is present.Due to the non-adjustability of the valve, an investigation of the braking force was not possible.Internal inspection of product: in order to verify whether the investigated shunt system was compromised by the known risks of hydrocephalus therapy, e.G.By a build-up of natural substances (protein, blood, or tissue particles) in the cerebrospinal fluid, the valves are finally opened with a special tool.After dismantling of the valves, deposits were found in both valves.Results: based on our investigation results, we have determined that there was an accelerated outflow and a non- adjustability in the shuntsystem at the time of our investigation.Detected deposits were the cause of the accelerated outflow and the non- adjustaility.Existing deposits in the csf can temporarily impair the function of the valve and is described as concomitant symptoms in hydrocephalus therapy.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 gmbh & co.Kg.From our point of view, no further regulatory actions are required.

• Brand Name: PROGAV SYSTEM M.SA 10 U.SPRUNG RES.
• Common Device Name: 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: 14323036
• Report Number: 3004721439-2022-00125
• Device Sequence Number: 11908869
• Product Code: JXG
• UDI-Device Identifier: 04041906132224
• UDI-Public: 4041906132224
• Combination Product (Y/N): N
• Initial Reporter Country: TW
• PMA/510(K) Number: K103003
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2020
• Device Explanted Year: 2022
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Other,Foreign,User Facility,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 06/14/2022

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: 11/26/2023
• Device Model Number: FV425T
• Device Catalogue Number: FV425T
• Device Lot Number: 20040351
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/11/2022
• Supplement Date Received by Manufacturer: 05/18/2022
• Initial Report FDA Received Date: 05/07/2022
• Supplement Report FDA Received Date: 06/16/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 01/09/2019
• 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: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 56 YR
• Patient Sex: Unknown
• Patient Weight: 75 KG