IMPLANTABLE COLLAMER LENS (ICL) VTICM5_13.2 N/A

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor,foreign,health pr report with the FDA on 2020-03-27 for IMPLANTABLE COLLAMER LENS (ICL) VTICM5_13.2 N/A manufactured by Staar Surgical Company.

Event Text Entries

[189089304] Pma/510k: this product is not marketed in the us. (b)(4).
Patient Sequence No: 1, Text Type: N, H10


[189089305] The reporter indicated that the surgeon implanted a 13. 2mm vticm5_13. 5, -13. 00/5. 0/100 (sphere/cylinder/axis) , implantable collamer lens into the patient's right eye (od) on (b)(6) 2020. The lens was removed and replaced on (b)(6) 2020 for a longer length lens due to lens rotation and low vault. This resolved the problem. Cause of the event is reported as unknown.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number2023826-2020-00583
MDR Report Key9889379
Report SourceDISTRIBUTOR,FOREIGN,HEALTH PR
Date Received2020-03-27
Date of Report2020-03-02
Date of Event2020-03-06
Date Mfgr Received2020-03-02
Device Manufacturer Date2019-12-26
Date Added to Maude2020-03-27
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 ContactMS. CYNTHIA THAI
Manufacturer Street1911 WALKER AVENUE
Manufacturer CityMONROVIA, CA
Manufacturer CountryUS
Manufacturer G1STAAR SURGICAL COMPANY
Manufacturer Street1911 WALKER AVENUE
Manufacturer CityMONROVIA, CA
Manufacturer CountryUS
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameIMPLANTABLE COLLAMER LENS (ICL)
Generic NamePHAKIC TORIC INTRAOCULAR LENS
Product CodeQCB
Date Received2020-03-27
Model NumberVTICM5_13.2
Catalog NumberN/A
Lot NumberN/A
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerSTAAR SURGICAL COMPANY
Manufacturer Address1911 WALKER AVENUE MONROVIA, CA US


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 2020-03-27

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