MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 06 report with the FDA on 2000-06-21 for HOOK LENS SINSKEY 6-250 manufactured by Bausch & Lomb Surgical.
[188039]
A small piece of the tip of the hook fell off into the pt's eye. This was not noticed until post op. Pt had to undergo a second procedure to remove foreign body.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1932180-2000-00004 |
| MDR Report Key | 282682 |
| Report Source | 06 |
| Date Received | 2000-06-21 |
| Date of Report | 2000-05-30 |
| Report Date | 2000-05-30 |
| Date Mfgr Received | 2000-05-30 |
| Date Added to Maude | 2000-06-23 |
| 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 |
| Manufacturer Contact | JACKIE PRATT |
| Manufacturer Street | 3365 TREE CT. INDUSTRIAL BLVD |
| Manufacturer City | ST. LOUIS MO 63122 |
| Manufacturer Country | US |
| Manufacturer Postal | 63122 |
| Manufacturer Phone | 6362263235 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | HOOK LENS SINSKEY |
| Generic Name | HOOK |
| Product Code | HNQ |
| Date Received | 2000-06-21 |
| Model Number | NA |
| Catalog Number | 6-250 |
| Lot Number | NA |
| ID Number | NA |
| Operator | UNKNOWN |
| Device Availability | Y |
| Device Age | UNKNOWN |
| Device Eval'ed by Mfgr | R |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 273554 |
| Manufacturer | BAUSCH & LOMB SURGICAL |
| Manufacturer Address | 499 SOVEREIGN CT. MANCHESTER MO 63011 US |
| Baseline Brand Name | HOOK LENS SINSKEY |
| Baseline Generic Name | OPHTHALMIC HOOK |
| Baseline Model No | NA |
| Baseline Catalog No | 6-250 |
| Baseline ID | NA |
| Baseline Device Family | OPHTHALMIC HOOK |
| Baseline Shelf Life [Months] | NA |
| Baseline PMA Flag | N |
| Baseline 510K PMN | N |
| Baseline Preamendment | N |
| Baseline Transitional | N |
| 510k Exempt | Y |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2000-06-21 |