| Brand Name | M.BLUE PLUS SYS W/CONTROL RESERVOIR |
| Common Device Name | HYDOROCEPHALUS 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 | 24860760 |
| Report Number | 3004721439-2026-00090 |
| Device Sequence Number | 13399244 |
| Product Code |
JXG
|
| UDI-Device Identifier | 04041906504830 |
| UDI-Public | (01)04041906504830(11)260128(17)310126(10)20087926 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | GM |
| PMA/510(K) Number | K192266 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2026 |
| Device Explanted Year | 2026 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,User Facility,Company Representative |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
04/13/2026 |
| 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 Model Number | FX824T |
| Device Catalogue Number | FX824T |
| Device Lot Number | 20087926 |
| Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
| Date Returned to Manufacturer | 03/17/2026 |
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 03/17/2026 |
| Initial Report FDA Received Date | 04/13/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 01/28/2026 |
| 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 | 60 YR |
| Patient Sex | Female |
| Patient Weight | 75 KG |