MAUDE MDR 454910

MDR report key
454910
Report number
1649914-2003-00021
Event key
0
Event type
3
Date of event
2003-03-06
Date received
2003-04-16
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
KATHRYN THOMPSON
Address
ONE ALLENTOWN PKWY ALLEN TX 75002 US
Phone
972-972-9723
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1LACRICATH 2.0MMLACRIMAL DUCT BALLOON CATHETERQUEST MEDICAL, INC.HNWLDC213*AM052802-1N*Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12003-04-160

Event Narratives#

D

Patient 1

THE CUSTOMER REPORTED THAT TWO CATHETERS WOULD NOT CONNECT TO THE INFLATOR. THE PT WAS ALREADY ANESTHETIZED. THE THIRD CATHETER WORKED.