MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 06,08 report with the FDA on 1998-11-05 for STORZ LIGHT PIPE, 20 GAUGE, 6/BOX MVS1011A manufactured by Bausch & Lomb Surgical.
[19235059]
This sterile product was rec'd with a slit in the packaging, rendering it unsterile. It was not used.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1920664-1998-00246 |
| MDR Report Key | 196429 |
| Report Source | 06,08 |
| Date Received | 1998-11-05 |
| Date of Report | 1998-10-08 |
| Date of Event | 1998-09-15 |
| Date Facility Aware | 1998-09-15 |
| Report Date | 1998-10-08 |
| Date Reported to Mfgr | 1998-10-07 |
| Date Mfgr Received | 1998-10-08 |
| Date Added to Maude | 1998-11-16 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 0 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | STORZ LIGHT PIPE, 20 GAUGE, 6/BOX |
| Generic Name | OPHTHALMIC LIGHT PIPE |
| Product Code | HBI |
| Date Received | 1998-11-05 |
| Model Number | NA |
| Catalog Number | MVS1011A |
| Lot Number | NA |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | * |
| Device Eval'ed by Mfgr | N |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 190841 |
| Manufacturer | BAUSCH & LOMB SURGICAL |
| Manufacturer Address | 3365 TREE COURT INDL. BLVD. ST. LOUIS MO 63122 US |
| Baseline Brand Name | STORZ LIGHT PIPE, 20 GAUGE, 6/BOX |
| Baseline Generic Name | FIBEROPTIC ENDOILLUMINATOR |
| Baseline Model No | NA |
| Baseline Catalog No | MVS1011A |
| Baseline ID | NA |
| Baseline Device Family | LIGHT PIPE |
| Baseline Shelf Life Contained | N |
| Baseline PMA Flag | N |
| Baseline 510K PMN | Y |
| Premarket Notification | K896549 |
| Baseline Preamendment | N |
| Baseline Transitional | N |
| 510k Exempt | N |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1998-11-05 |