MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2013-08-05 for FORM FIT HYDROGEL CANALICULAR PLUG 6303 manufactured by Oasis Medical, Inc..
[3712042]
Reported observation: patient developed chronic canaliculitis after insertion of an oasis medical form fit hydrogel canalicular plug.
Patient Sequence No: 1, Text Type: D, B5
[10908024]
Reported event: patient developed chronic canaliculitis. Product reference: 6303. Product lot number: not reported. Product inserted on: not reported. Date of complication: not reported. Reported to oasis medical, inc. On (b)(6) 2013. Discussion: the initial reporter was contacted to request case specific information. Oasis was advised that the office was too busy to provide the requested information. The device was not returned for evaluation. No conclusion can be drawn as to the direct cause of the reported adverse event.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2083373-2013-00003 |
| MDR Report Key | 3284645 |
| Report Source | 05 |
| Date Received | 2013-08-05 |
| Date of Report | 2013-08-01 |
| Date of Event | 2013-07-09 |
| Date Mfgr Received | 2012-03-12 |
| Date Added to Maude | 2013-08-23 |
| 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 | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | NICOLA HUBERT, MANAGER |
| Manufacturer Street | 514 S. VERMONT AVE. |
| Manufacturer City | GLENDORA CA 91741 |
| Manufacturer Country | US |
| Manufacturer Postal | 91741 |
| Manufacturer Phone | 6268525182 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | FORM FIT HYDROGEL CANALICULAR PLUG |
| Generic Name | INTRACANALICULAR PLUG |
| Product Code | LZU |
| Date Received | 2013-08-05 |
| Model Number | 6303 |
| Catalog Number | 6303 |
| Lot Number | NOT REPORTED |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | OASIS MEDICAL, INC. |
| Manufacturer Address | 514 S. VERMONT AVE. GLENDORA CA 91741 US 91741 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2013-08-05 |