MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2013-10-30 for EAGLE PLUG1 3001 manufactured by Eagle Vision, Inc..
[3938167]
Physician reported the pt developed a pyrogenic granuloma in the inferior punctum of the lower lid. The plug was explanted and the pt was treated with lotemax every 2 hours for 2 days then 4 times a day for 2 weeks.
Patient Sequence No: 1, Text Type: D, B5
[11245467]
No add'l info.
Patient Sequence No: 1, Text Type: N, H10
Report Number | 1034718-2013-00007 |
MDR Report Key | 3449668 |
Report Source | 05 |
Date Received | 2013-10-30 |
Date of Report | 2013-10-03 |
Date of Event | 2013-05-10 |
Date Mfgr Received | 2013-10-03 |
Device Manufacturer Date | 2012-10-01 |
Date Added to Maude | 2013-11-06 |
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 |
Reporter Occupation | PHYSICIAN ASSISTANT |
Health Professional | 3 |
Initial Report to FDA | 3 |
Report to FDA | 0 |
Event Location | 0 |
Manufacturer Contact | MR. BILL GRAHAM, MGR. |
Manufacturer Street | 8500 WOLF LAKE DR. SUITE 110 |
Manufacturer City | MEMPHIS TN 38133 |
Manufacturer Country | US |
Manufacturer Postal | 38133 |
Manufacturer Phone | 9013807000 |
Single Use | 3 |
Previous Use Code | 3 |
Event Type | 3 |
Type of Report | 3 |
Brand Name | EAGLE PLUG1 |
Generic Name | PUNCTUM PLUG |
Product Code | LZU |
Date Received | 2013-10-30 |
Catalog Number | 3001 |
Lot Number | 77556 |
Device Expiration Date | 2017-10-31 |
Operator | HEALTH PROFESSIONAL |
Device Availability | N |
Device Age | DA |
Device Eval'ed by Mfgr | R |
Device Sequence No | 1 |
Device Event Key | 0 |
Manufacturer | EAGLE VISION, INC. |
Manufacturer Address | MEMPHIS TN US |
Patient Number | Treatment | Outcome | Date |
---|---|---|---|
1 | 0 | 1. Required No Informationntervention | 2013-10-30 |