MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,04 report with the FDA on 2004-10-27 for ALLERGAN CUP (GORETEX) manufactured by Allergan, Inc..
[19250744]
The manufacturer of a contact lens care cup for use with 3 percent hydrogen peroxide systems received a report from another country that a lens case exploded. No patient injury was reported. The lens cup is unavailable for evaluation.
Patient Sequence No: 1, Text Type: D, B5
[19343452]
Cup unavailable for evaluation.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2020664-2004-00026 |
| MDR Report Key | 903973 |
| Report Source | 01,04 |
| Date Received | 2004-10-27 |
| Date of Event | 2004-07-06 |
| Date Mfgr Received | 2004-07-06 |
| Date Added to Maude | 2007-08-29 |
| 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 | PAUL NOWACKI |
| Manufacturer Street | 1700 E. ST. ANDREW PLACE |
| Manufacturer City | SANTA ANA CA 92705 |
| Manufacturer Country | US |
| Manufacturer Postal | 92705 |
| Manufacturer Phone | 7142478601 |
| Manufacturer G1 | ALLERGAN |
| Manufacturer Street | 8301 MARS DRIVE |
| Manufacturer City | WACO TX 76712 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 76712 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ALLERGAN CUP (GORETEX) |
| Generic Name | CONTACT LENS CARE PRODUCT |
| Product Code | HRD |
| Date Received | 2004-10-27 |
| Model Number | NA |
| Catalog Number | NA |
| Lot Number | NA |
| ID Number | * |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Eval'ed by Mfgr | N |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 879005 |
| Manufacturer | ALLERGAN, INC. |
| Manufacturer Address | 8301 MARS DRIVE WACO TX 76712 US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2004-10-27 |