MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2016-12-25 for LACRIFAST LF-R105 manufactured by Kaneka Corporation.
[63615943]
-the concerned device "lacrifast" is not distributed in us under this device name, but is identical to the device "lacriflow lacrimal stent" distributed in us under 510(k) # k120886. - the actual device used was returned and investigated:the stainless steel ring mounted in the tip of the colored in blue tube was dismounted and missing. The outer/inner diameters, length, and all other dimensions of both tubes were confirmed within the specifications. - as a possible cause of the penetration of the bougie and dropping off the ring during the use, we speculate as follows: when the doctor tried to insert and advance the tube with the bougie inserted forcibly in the occluded lacrimal duct, excessive mechanical force was loaded on the ring and the distal tip of the tube where the ring was mounted, and further pushing the bougie resulted in dismounting the ring and penetration of the ring with the bougie out of the tube.
Patient Sequence No: 1, Text Type: N, H10
[63615944]
The doctor opened the lacrimal duct by using dacryoendoscopy and a sheath, then he inserted one of the lacrimal duct tube (colored in blue) into the lacrimal duct by g-sgi(goto-sheath guided intubation) technique. The doctor felt that the bougie penetrated out of the tube and retrieved it out of the patient's lacrimal duct.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9614654-2015-00014 |
| MDR Report Key | 6203721 |
| Date Received | 2016-12-25 |
| Date of Report | 2015-08-13 |
| Date of Event | 2015-07-30 |
| Date Mfgr Received | 2015-08-13 |
| Device Manufacturer Date | 2015-03-05 |
| Date Added to Maude | 2016-12-25 |
| 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 | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. KAZUHIKO INOUE |
| Manufacturer Street | 2-3-18 NAKANOSHIMA, KITA-KU |
| Manufacturer City | OSAKA, 530-8288 |
| Manufacturer Country | JA |
| Manufacturer Postal | 530-8288 |
| Manufacturer Phone | 4613072 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | LACRIFAST |
| Generic Name | LACRIMAL STENT |
| Product Code | OKS |
| Date Received | 2016-12-25 |
| Catalog Number | LF-R105 |
| Lot Number | KP025478 |
| Device Expiration Date | 2018-02-28 |
| Device Availability | Y |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | KANEKA CORPORATION |
| Manufacturer Address | 2-3-18, NAKANOSHIMA, KITA-KU, OSAKA, 530-8288 JA 530-8288 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2016-12-25 |