MAUDE Adverse Event Report: MEDTRONIC NEUROSURGERY VENTRICULAR CATHETER WITH BIOGLIDE, STANDARD, 23 CM; SHUNT, CENTRAL NERVOUS SYSTEM AND COMPONENTS

Catalog Number	91503
Medical Device Problem Code	Device Operates Differently Than Expected (2913)
Health Effect - Clinical Code	Therapeutic Response, Decreased (2271)
Date of Event	02/12/2017
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
If information is provided in the future, a supplemental report will be issued.
Event or Problem Description
It was reported to medtronic neurosurgery that after several regulatory pressures, the shunt effect was still not obvious, and the patient's condition did not decrease.According to the report, the patient was relieved when the valve was replaced, and the doctor suspected a valve failure.
Additional Manufacturer Narrative
If information is provided in the future, a supplemental report will be issued.
Additional Manufacturer Narrative
If information is provided in the future, a supplemental report will be issued.
Additional Manufacturer Narrative
Approximately 19.5 cm of the ventricular catheter was returned.The returned catheter was patent and met the requirements for leak testing.Therefore the complaint could not be duplicated by laboratory personnel.There was proteinaceous debris observed within the interior and exterior of the catheter.The instructions for use that accompany the device caution that ¿shunt obstruction may occur in any of the components of the shunt system.The system may become occluded internally due to tissue fragments, blood clots, tumor cell aggregates, bacterial colonization, or other debris.¿ a review of the manufacturing records showed no anomalies.All catheters are 100% inspected at the time of the manufacture.If information is provided in the future, a supplemental report will be issued.
Event or Problem Description
Additional information received reported the doctor adjusted the setting four times, from 2.0 to 1.5 to 1.0 to 0.5, with an interval of two days between adjustments.

• Brand Name: VENTRICULAR CATHETER WITH BIOGLIDE, STANDARD, 23 CM
• Common Device Name: SHUNT, CENTRAL NERVOUS SYSTEM AND COMPONENTS
• Manufacturer (Section D): MEDTRONIC NEUROSURGERY; 125 cremona drive; goleta CA 93117
• MDR Report Key: 6664092
• Report Number: 2021898-2017-00345
• Device Sequence Number: 13463617
• Product Code: JXG
• UDI-Device Identifier: 00613994800718
• UDI-Public: 00613994800718
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K951258
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2017
• Device Explanted Year: 2017
• Reporter Type: Manufacturer
• Report Source: foreign,health professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup,Followup
• Report Date (Section B): 10/10/2017

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: 07/31/2018
• Device Catalogue Number: 91503
• Device Lot Number: D52330
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/07/2017
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/25/2017
• Supplement Date Received by Manufacturer: 07/10/2017; 07/10/2017; 09/18/2017
• Initial Report FDA Received Date: 06/23/2017
• Supplement Report FDA Received Date: 08/08/2017; 09/07/2017; 10/10/2017
• 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: Hospitalization; Required Intervention
• Patient Age: 54 YR
• Patient Weight: 54