MAUDE MDR 8147723

MDR report key
8147723
Report number
1423395-2018-00063
Event key
0
Event type
3
Date of event
2018-11-26
Date received
2018-12-10
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
2
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
BERMON PUNZALAN
Address
THREE LAKES DRIVE NORTHFIELD IL 60093 US
Phone
224-224-2249
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1GAUZE FROM EYE PACKMEDLINE INDUSTRIES INC.OJKDYNJ6011318HDB581R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12018-12-1001. R

Event Narratives#

N

Patient 1

IT WAS REPORTED THAT AT THE BEGINNING OF THE EYE/CATARACT/IOL/IMPLANT PROCEDURE, WHEN THE PATIENT'S EYE WAS LOOKED AT UNDER A MICROSCOPE, IT WAS DISCOVERED BY THE PHYSICIAN THAT THERE WAS A LINT PARTICULATE FLOATING ON PATIENT'S LENS. THE LINT PARTICULATE WAS REPORTEDLY POSSIBLY FROM THE GAUZE LOCATED IN THE PREP TRAY FROM THE CUSTOM SURGICAL PACK (EYE PACK). IT WAS ADDED THAT THE LINT PARTICULATE REACHED THE PATIENT'S EYE/LENS WHEN MEDICATION FROM THE MEDICINE CUP WAS ADMINISTERED TO THE PATIENT'S EYE. PER REPORT, THE CUSTOM SURGICAL PACK'S INTEGRITY WAS VERIFIED PRIOR TO USE AND THE LINT PARTICULATE WAS NOT IDENTIFIED IN THE MEDICINE CUP AT THAT TIME. IT WAS REPORTED THAT IRRIGATION WAS REQUIRED TO REMOVE THE LINT PARTICULATE FROM THE PATIENT'S EYE/LENS. THE PATIENT WAS UNDER SEDATION AT THE TIME OF THE INCIDENT AND THERE WAS NO REPORT OF ADDITIONAL SEDATION MEDICATION REQUIRED. IMMEDIATELY IN THE POST-OPERATIVE PHASE, THE PATIENT WAS REPORTEDLY WELL. NO IMPACT TO THE PATIENT, THE PROCEDURE, OR THE TOTAL LENGTH OF THE PROCEDURE WAS REPORTED. THERE WAS NO SERIOUS INJURY OR FOLLOW UP CARE REPORTED RELATED TO THE EVENT. DUE TO THE REPORTED INCIDENT AND MEDICAL INTERVENTION, THIS MEDWATCH IS BEING FILED. THE SAMPLE IS NOT AVAILABLE TO BE RETURNED FOR EVALUATION. A ROOT CAUSE COULD NOT BE DETERMINED AT THIS TIME. NO ADDITIONAL INFORMATION IS AVAILABLE. IF ADDITIONAL INFORMATION BECOMES AVAILABLE, A SUPPLEMENTAL MEDWATCH WILL BE FILED.

D

Patient 1

IT WAS REPORTED THAT IRRIGATION WAS REQUIRED TO REMOVE THE LINT PARTICULATE THAT WAS DISCOVERED FLOATING ON THE PATIENT'S LENS.