MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional,user faci report with the FDA on 2017-04-13 for MALYUGIN RING SYSTEM MAL-1001 manufactured by Microsurgical Technology Inc..
[72738517]
The device was returned for evaluation deformed and the evaluation was therefore unable to determine the cause of the failure.
Patient Sequence No: 1, Text Type: N, H10
[72738518]
During cataract surgery, upon insertion of an iol the haptic of the iol caught the malyugin ring scroll and pulled the ring into the capsular bag tearing it. A vitrectomy was performed and a sulcus iol was implanted. The patient was reported to be doing very well post-op.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3019924-2017-00006 |
| MDR Report Key | 6490470 |
| Report Source | HEALTH PROFESSIONAL,USER FACI |
| Date Received | 2017-04-13 |
| Date of Report | 2017-04-04 |
| Date of Event | 2017-03-15 |
| Date Mfgr Received | 2017-03-15 |
| Device Manufacturer Date | 2017-01-30 |
| Date Added to Maude | 2017-04-13 |
| 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. JOHN RAY |
| Manufacturer Street | 8415 154TH AVE NE |
| Manufacturer City | REDMOND WA 98052 |
| Manufacturer Country | US |
| Manufacturer Postal | 98052 |
| Manufacturer Phone | 4255560544 |
| Manufacturer G1 | MICROSURGICAL TECHNOLOGY INC |
| Manufacturer Street | 8415 154TH AVE NE |
| Manufacturer City | REDMOND WA 98052 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 98052 |
| Single Use | 3 |
| Remedial Action | RL |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | MALYUGIN RING SYSTEM |
| Generic Name | CLIP, IRIS RETRACTOR |
| Product Code | HOC |
| Date Received | 2017-04-13 |
| Returned To Mfg | 2017-03-27 |
| Model Number | MAL-1001 |
| Catalog Number | MAL-1001 |
| Lot Number | 084930 |
| Operator | PHYSICIAN |
| Device Availability | R |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | MICROSURGICAL TECHNOLOGY INC. |
| Manufacturer Address | 8415 154TH AVE NE REDMOND WA 98052 US 98052 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2017-04-13 |