RAY-BAN PREDATOR W1847

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 04,05 report with the FDA on 1998-12-07 for RAY-BAN PREDATOR W1847 manufactured by Bausch & Lomb, Inc..

Event Text Entries

[19545239] Consumer alleges an injury requiring medical treatment, caused by his sunglasses when he was struck by a pebble while riding his motorcycle.
Patient Sequence No: 1, Text Type: D, B5

MAUDE Entry Details

• Report Number: 1643383-1998-00002
• MDR Report Key: 201194
• Report Source: 04,05
• Date Received: 1998-12-07
• Date of Report: 1998-10-23
• Date of Event: 1996-04-28
• Date Added to Maude: 1998-12-14
• 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
• Remedial Action: OT
• Previous Use Code: 3
• Removal Correction Number: NA
• Event Type: 3
• Type of Report: 3

Device Details

• Brand Name: RAY-BAN
• Generic Name: SUNGLASS
• Product Code: HQY
• Date Received: 1998-12-07
• Model Number: PREDATOR
• Catalog Number: W1847
• Lot Number: NA
• ID Number: NA
• Operator: LAY USER/PATIENT
• Device Availability: Y
• Device Age: NA
• Device Eval'ed by Mfgr: *
• Implant Flag: N
• Date Removed: A
• Device Sequence No: 1
• Device Event Key: 195429
• Manufacturer: BAUSCH & LOMB, INC.
• Manufacturer Address: 5335 CASTROVILLE RD. SAN ANTONIO TX 78227 US
• Baseline Brand Name: RAY-BAN SUNGLASSES
• Baseline Generic Name: SUNGLASSES
• Baseline Model No: PREDATOR
• Baseline Catalog No: W1999
• Baseline ID: NA
• Baseline Device Family: NA
• Baseline Shelf Life [Months]: NA
• Baseline PMA Flag: N
• Baseline 510K PMN: N
• Baseline Preamendment: Y
• Baseline Transitional: N
• 510k Exempt: Y

Patients

Patient Number	Treatment	Outcome	Date
1	0	1. Required No Informationntervention	1998-12-07