FIBER OPTIC ILLUMINATOR 8065751577

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2020-02-19 for FIBER OPTIC ILLUMINATOR 8065751577 manufactured by Alcon Research, Llc - Houston.

Event Text Entries

[183727291] Investigation, including root cause analysis, is in progress. A supplemental mdr will be filed as necessary in accordance with 21 cfr 803. 56 when additional reportable information becomes available. The manufacturer internal reference number is: (b)(4).
Patient Sequence No: 1, Text Type: N, H10


[183727292] A customer reported that the green ring of the trocar cannula came off the shaft during a procedure. The product was replaced and the procedure was completed. There was no patient harm.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1644019-2020-00097
MDR Report Key9730983
Report SourceCOMPANY REPRESENTATIVE,FOREIG
Date Received2020-02-19
Date of Report2020-02-19
Date of Event2020-01-29
Date Mfgr Received2020-01-30
Device Manufacturer Date2019-09-11
Date Added to Maude2020-02-19
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag0
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMR. JONATHAN SCHLECH
Manufacturer Street6201 SOUTH FREEWAY MAIL STOP AB2-6
Manufacturer CityFORT WORTH TX 76134
Manufacturer CountryUS
Manufacturer Postal76134
Manufacturer Phone8175514979
Manufacturer G1ALCON RESEARCH, LLC - HOUSTON
Manufacturer Street9965 BUFFALO SPEEDWAY
Manufacturer CityHOUSTON TX 77054
Manufacturer CountryUS
Manufacturer Postal Code77054
Single Use3
Previous Use Code3
Removal Correction NumberNA
Event Type3
Type of Report3

Device Details

Brand NameFIBER OPTIC ILLUMINATOR
Generic NameLIGHT, SURGICAL, FIBEROPTIC
Product CodeFST
Date Received2020-02-19
Model NumberNA
Catalog Number8065751577
Lot Number2318836H
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerALCON RESEARCH, LLC - HOUSTON
Manufacturer Address9965 BUFFALO SPEEDWAY HOUSTON TX 77054 US 77054


Patients

Patient NumberTreatmentOutcomeDate
10 2020-02-19

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