JAMIE EYEQ 40SQ.18 125MM MAT BROWN *

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2002-04-07 for JAMIE EYEQ 40SQ.18 125MM MAT BROWN * manufactured by *.

Event Text Entries

[20758136] Went through 2 pairs of glasses within 4 mos. Both broke in the same place. Mfr, dr or medicare will not cover them on any type of warranty.
Patient Sequence No: 1, Text Type: D, B5

MAUDE Entry Details

• Report Number: MW1024684
• MDR Report Key: 388048
• Date Received: 2002-04-07
• Date of Report: 2002-04-07
• Date Added to Maude: 2002-04-16
• Event Key: 0
• Report Source Code: Voluntary report
• Manufacturer Link: N
• Number of Patients in Event: 0
• Adverse Event Flag: 3
• Product Problem Flag: 3
• Reprocessed and Reused Flag: 0
• Reporter Occupation: PATIENT
• Health Professional: 3
• Initial Report to FDA: 0
• Report to FDA: 0
• Event Location: 3
• Single Use: 0
• Previous Use Code: 0
• Event Type: 3
• Type of Report: 3

Device Details

• Brand Name: JAMIE EYEQ
• Generic Name: EYE GLASSES +1.50 +350
• Product Code: HQG
• Date Received: 2002-04-07
• Model Number: 40SQ.18 125MM MAT BROWN
• Catalog Number: *
• Lot Number: *
• ID Number: *
• Device Availability: Y
• Implant Flag: N
• Date Removed: *
• Device Sequence No: 1
• Device Event Key: 377083
• Manufacturer: *
• Manufacturer Address: * * *

Patients

Patient Number	Treatment	Outcome	Date
1	0	1. Other	2002-04-07