MIRA CR4000 OPHTHALMIC CRYO UNIT CR4010

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 06 report with the FDA on 2010-11-23 for MIRA CR4000 OPHTHALMIC CRYO UNIT CR4010 manufactured by Mira, Inc..

Event Text Entries

[21430101] Excessive leaking from probe tip.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1218813-2010-00017
MDR Report Key1910839
Report Source06
Date Received2010-11-23
Date of Report2010-11-19
Date of Event2010-06-22
Device Manufacturer Date2009-01-01
Date Added to Maude2011-02-25
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location0
Manufacturer Street414 QUAKER HIGHWAY
Manufacturer CityUXBRIDGE MA 01527
Manufacturer CountryUS
Manufacturer Postal01527
Single Use3
Remedial ActionMA
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameMIRA CR4000 OPHTHALMIC CRYO UNIT
Product CodeHPS
Date Received2010-11-23
Model NumberCR4010
Catalog NumberCR4010
Lot Number0109
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device AgeDA
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerMIRA, INC.
Manufacturer AddressUXBRIDGE MA US


Patients

Patient NumberTreatmentOutcomeDate
10 2010-11-23

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