MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 06 report with the FDA on 2006-04-12 for LACRICATH LACRIMAL DUCT CATHETER, 3.0MM LDC315 * manufactured by Quest Medical, Inc..
[446434]
The customer reported that during a dcp procedure, the balloon catheter was "defective". Another catheter was used to complete the procedure without any compications. The complaint sample was saved and will be returned to quest for evaluation. The device is packaged in a kit. Lot 23792. The part number of the device that allegedly failed is ldc315, from either lot 23678. 04t or 23373. 07s. This mdr will be filed on the lcd315 code.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1649914-2006-00009 |
| MDR Report Key | 701295 |
| Report Source | 06 |
| Date Received | 2006-04-12 |
| Date of Report | 2006-02-08 |
| Date of Event | 2005-12-14 |
| Date Mfgr Received | 2005-12-14 |
| Device Manufacturer Date | 2005-03-01 |
| Date Added to Maude | 2006-04-21 |
| 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 | 0 |
| Manufacturer Contact | KATHRYN JAYNE |
| Manufacturer Street | ONE ALLENTOWN PARKWAY |
| Manufacturer City | ALLEN TX 75002 |
| Manufacturer Country | US |
| Manufacturer Postal | 75002 |
| Manufacturer Phone | 9723909800 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | LACRICATH LACRIMAL DUCT CATHETER, 3.0MM |
| Generic Name | MANUAL OPHTHALMIC SURGICAL INSTRUMENT: LACRYMAL DILATOR |
| Product Code | HMW |
| Date Received | 2006-04-12 |
| Model Number | LDC315 |
| Catalog Number | * |
| Lot Number | 23678.04T OR 23373.07S |
| ID Number | * |
| Device Expiration Date | 2007-03-15 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 690403 |
| Manufacturer | QUEST MEDICAL, INC. |
| Manufacturer Address | ONE ALLENTOWN PKWY. ALLEN TX 75002 US |
| Baseline Brand Name | LACRICATH LACRIMAL DUCT CATHETER, 3.0MM |
| Baseline Generic Name | MANUAL OPHTHALMIC SURGICAL INSTRUMENT LACRYMAL DILATOR |
| Baseline Model No | LDC315 |
| Baseline Catalog No | * |
| Baseline ID | * |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2006-04-12 |