GELLANSERT TEMPORARY PUNCTUM PLUG 0040

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,05,06 report with the FDA on 2014-04-29 for GELLANSERT TEMPORARY PUNCTUM PLUG 0040 manufactured by Eagle Vision, Inc..

Event Text Entries

[22137159] Physician reported that gellansert temporary punctum plugs were used on a prk patient post surgery. The plugs were placed in the patient to increase the retention of ocular medication. The patient has had persistent canaliculitis od. Patient has had irrigation of the canaliculus twice, but without full resolution of the symptoms.
Patient Sequence No: 1, Text Type: D, B5


[22208065] It was reported that the forceps used for inserting the gellansert plugs were cleaned with alcohol wipes. This is the 2nd of 3 reports from the same reporter on the product.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number1034718-2014-00002
MDR Report Key3788310
Report Source01,05,06
Date Received2014-04-29
Date of Report2014-04-24
Date Mfgr Received2014-03-24
Date Added to Maude2014-05-06
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location0
Manufacturer ContactMR. BILL GRAHAM
Manufacturer Street8500 WOLF LAKE DR. SUITE 110
Manufacturer CityMEMPHIS TN 38133
Manufacturer CountryUS
Manufacturer Postal38133
Manufacturer Phone9013807000
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameGELLANSERT TEMPORARY PUNCTUM PLUG
Generic NamePUNCTUM PLUG
Product CodeLZU
Date Received2014-04-29
Catalog Number0040
Lot NumberUNK
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrN
Device Sequence No1
Device Event Key0
ManufacturerEAGLE VISION, INC.
Manufacturer AddressMEMPHIS TN US


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 2014-04-29

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