SEARS OPTICAL *

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2003-07-24 for SEARS OPTICAL * manufactured by Sears Optical Montclair Plaza.

Event Text Entries

[21959099] Unable to get correct prescription glasses from sears optical.
Patient Sequence No: 1, Text Type: D, B5

MAUDE Entry Details

• Report Number: MW1029110
• MDR Report Key: 474188
• Date Received: 2003-07-24
• Date of Report: 2003-07-24
• Date of Event: 1998-10-10
• Date Added to Maude: 2003-07-30
• 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: SEARS OPTICAL
• Generic Name: GLASSES
• Product Code: HOI
• Date Received: 2003-07-24
• Model Number: *
• Catalog Number: *
• Lot Number: *
• ID Number: *
• Operator: LAY USER/PATIENT
• Device Availability: *
• Implant Flag: N
• Date Removed: *
• Device Sequence No: 1
• Device Event Key: 463034
• Manufacturer: SEARS OPTICAL MONTCLAIR PLAZA
• Manufacturer Address: * MONTCLAIR CA * US

Patients

Patient Number	Treatment	Outcome	Date
1	0	1. Other	2003-07-24