MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 2002-06-22 for 3000 LE ND: YAG LASER manufactured by Alcon - Irvine Technology Center.
[270026]
Reporter noted system was counting shots fired, but wasn't firing. Couldn't complete procedure and had to reschedule. No patient unjury occurred.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2028159-2002-00162 |
| MDR Report Key | 401991 |
| Report Source | 07 |
| Date Received | 2002-06-22 |
| Date of Report | 2002-05-23 |
| Date Mfgr Received | 2002-05-23 |
| Date Added to Maude | 2002-07-01 |
| 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 | 0 |
| Manufacturer Contact | CHARLES DOLBEE |
| Manufacturer Street | 6201 SOUTH FREEWAY |
| Manufacturer City | FORTH WORTH TX 631342099 |
| Manufacturer Country | US |
| Manufacturer Postal | 631342099 |
| Manufacturer Phone | 8175518317 |
| Manufacturer G1 | ALCON - IRVINE TECHNOLOGY CENTER |
| Manufacturer Street | 15800 ALTON PARKWAY |
| Manufacturer City | IRVINE CA 92618 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 92618 |
| Single Use | 3 |
| Remedial Action | OT |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | 3000 LE ND: YAG LASER |
| Generic Name | LASER PHOTODISRUPTER |
| Product Code | LXS |
| Date Received | 2002-06-22 |
| Model Number | 3000 LE |
| Catalog Number | 3000 LE |
| Lot Number | NA |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 391017 |
| Manufacturer | ALCON - IRVINE TECHNOLOGY CENTER |
| Manufacturer Address | 15800 ALTON PKWY. IRVINE CA 926183818 US |
| Baseline Brand Name | 3000 LE ND: YAG PHOTODISRUPTER |
| Baseline Generic Name | LASER PHOTODISRUPTER |
| Baseline Model No | 3000 LE |
| Baseline Catalog No | 3000 LE |
| Baseline ID | NA |
| Baseline Device Family | P-DISRUPTER |
| Baseline Shelf Life Contained | A |
| Baseline Shelf Life [Months] | 60 |
| Baseline PMA Flag | N |
| Baseline 510K PMN | Y |
| Premarket Notification | K882772 |
| Baseline Preamendment | N |
| Baseline Transitional | N |
| 510k Exempt | N |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2002-06-22 |