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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDTRONIC MEXICO S. DE R.L. DE CV EXACTA DRAINAGE SYSTEM, 100ML; DEVICE, MONITORING, INTRACRANIAL PRESSURE

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MEDTRONIC MEXICO S. DE R.L. DE CV EXACTA DRAINAGE SYSTEM, 100ML; DEVICE, MONITORING, INTRACRANIAL PRESSURE Back to Search Results
Model Number 46705
Medical Device Problem Code Fluid/Blood Leak (1250)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 04/01/2026
Type of Reportable Event Malfunction
Event or Problem Description
Medtronic received information regarding an external drainage and monitoring system.It was reported that on (b)(6) 2026, after the device had been used for external ventricular drainage for 2 hours on patient, rupture with blood oozing was observed at the ventricular-end connection interface of the device.Therefore, a new device was used instead and connected to continue drainage.There was a procedure delay of 30 minutes.The patient's status at the time of the report was alive-with injury as the patient had hydrocephalus, which was not caused by the device used in this procedure.
 
Additional Manufacturer Narrative
Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.
 
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Brand Name
EXACTA DRAINAGE SYSTEM, 100ML
Common Device Name
DEVICE, MONITORING, INTRACRANIAL PRESSURE
Manufacturer (Section D)
MEDTRONIC MEXICO S. DE R.L. DE CV
av. paseo del cucapah #10510
tijuana,bc 22210
MX  22210
Manufacturer (Section G)
MEDTRONIC MEXICO S. DE R.L. DE CV
av. paseo del cucapah #10510
tijuana,bc 22210
MX   22210
Manufacturer Contact
justin ellis
4620 n. beach st.
fort worth, TX 76137
7635265677
MDR Report Key24799258
Report Number9617601-2026-02296
Device Sequence Number16122028
Product Code GWM
UDI-Device Identifier00763000333706
UDI-Public(01)00763000333706(17)291011(10)230026095
Combination Product (Y/N)N
Initial Reporter CountryCH
PMA/510(K) Number
K201118
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source Foreign,Health Professional,Company Representative
Initial Reporter Occupation Physician
Type of Report Initial,Followup
Report Date (Section B) 06/01/2026
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? Yes
Operator of Device Health Professional
Device Model Number46705
Device Catalogue Number46705
Device Lot Number230026095
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 04/01/2026
Supplement Date Received by Manufacturer05/29/2026
Initial Report FDA Received Date04/07/2026
Supplement Report FDA Received Date06/01/2026
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured11/11/2024
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 Number1
Patient Age55 YR
Patient SexMale
Patient Weight73 KG
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