UNKNOWN

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2020-03-25 for UNKNOWN manufactured by Johnson & Johnson Surgical Vision, Inc..

Event Text Entries

[188490321] Brand name: unknown, as the serial number was not provided. Model number: unknown, as the serial number was not provided. Serial number: unknown, information not provided. Udi number: unknown, as the serial number was not provided. Catalog number: unknown, as the serial number was not provided. Expiration date: unknown, as the serial number was not provided. If explanted, give date: not applicable, as the lens remains implanted; therefore, it was not explanted. Initial reporter phone number, facility name, and address were not provided. Pma/510(k) #: unknown, as the serial number was not provided. Device manufacture date: unknown, as the serial number was not provided. The lens remains implanted. There was no model/lot/serial number reported for this device; therefore, no further investigation can be performed. If there is any further relevant information received, a supplemental medwatch will be filed. All pertinent information available to johnson & johnson surgical vision, inc. Has been submitted.
Patient Sequence No: 1, Text Type: N, H10


[188490322] It was reported in a masked clinical study that a patient was implanted bilateral intraocular lenses. During the 1st month visit the patient had very bothersome halos and starbursts. The 1 month best corrected visual acuity was right eye (od)-80, left eye (os)-87. However, at 6th month follow-up visit, the best corrected distance visual acuity (bcvda) are noted to be od-85, os-87 (ou) both eyes bcdva: 20/16) etdrs (early treatment diabetic retinopathy study) letters read. Moreover, the subject is still complaining of very bothersome halos and starbursts. There is no plan for surgical intervention. No other information was provided. This mdr report pertains to the right eye (od). A separate report will be submitted for the left eye (os).
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number9614546-2020-00143
MDR Report Key9876320
Report SourceCOMPANY REPRESENTATIVE,HEALTH
Date Received2020-03-25
Date of Report2020-03-24
Date of Event2019-11-07
Report Date2005-01-01
Date Reported to FDA2005-01-01
Date Reported to Mfgr2005-01-10
Date Mfgr Received2020-02-24
Date Added to Maude2020-03-25
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactSOMYATA NAGPAL
Manufacturer Street1700 EAST ST. ANDREW PLACE
Manufacturer CitySANTA ANA CA 92705
Manufacturer CountryUS
Manufacturer Postal92705
Manufacturer Phone7142478200
Manufacturer G1JOHNSON & JOHNSON SURGICAL VISION, INC.
Manufacturer StreetVAN SWIETENLAAN 5
Manufacturer CityGRONINGEN 9728NX
Manufacturer CountryNL
Manufacturer Postal Code9728 NX
Single Use0
Previous Use Code0
Event Type3
Type of Report3

Device Sequence Number: 1

Generic NameMULTIFOCAL IOLS
Product CodeMFK
Date Received2020-03-25
Model NumberUNKNOWN
Catalog NumberUNKNOWN
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Sequence No1
Device Event Key0
ManufacturerJOHNSON & JOHNSON SURGICAL VISION, INC.
Manufacturer Address1700 E ST ANDREW PLACE SANTA ANA CA 92705 US 92705

Device Sequence Number: 101

Product Code---
Date Received2020-03-25
Device Sequence No101
Device Event Key0


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2020-03-25

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