MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 04,05 report with the FDA on 1997-01-10 for RAY-BAN SUNGLASS PREDATOR W1999 manufactured by Bausch & Lomb Inc..
[40559]
Customer alleged an injury involving his sunglasses when he struck his face on a shopping cart rack.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1643383-1997-00001 |
| MDR Report Key | 61917 |
| Report Source | 04,05 |
| Date Received | 1997-01-10 |
| Date of Report | 1997-01-09 |
| Date of Event | 1996-04-05 |
| Date Mfgr Received | 1996-12-12 |
| Date Added to Maude | 1997-01-15 |
| 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 | 3 |
| Single Use | 3 |
| Remedial Action | OT |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | RAY-BAN SUNGLASS |
| Generic Name | SUNGLASS |
| Product Code | HQY |
| Date Received | 1997-01-10 |
| Returned To Mfg | 1996-05-02 |
| Model Number | PREDATOR |
| Catalog Number | W1999 |
| Lot Number | NA |
| ID Number | * |
| Operator | LAY USER/PATIENT |
| Device Availability | R |
| Device Age | NA |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Date Removed | * |
| Device Sequence No | 1 |
| Device Event Key | 62257 |
| Manufacturer | BAUSCH & LOMB INC. |
| Manufacturer Address | 5335 CASTROVILLE RD SAN ANTONIO TX 78227 US |
| Baseline Brand Name | RAY-BAN SUNGLASSES |
| Baseline Generic Name | SUNGLASSES |
| Baseline Model No | PREDATOR |
| Baseline Catalog No | W1999 |
| Baseline ID | NA |
| Baseline Device Family | NA |
| Baseline Shelf Life [Months] | NA |
| Baseline PMA Flag | N |
| Baseline 510K PMN | N |
| Baseline Preamendment | Y |
| Baseline Transitional | N |
| 510k Exempt | Y |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 1997-01-10 |