MAUDE MDR 9897127

MDR report key
9897127
Report number
2023826-2020-00642
Event key
0
Event type
3
Date of event
2019-02-25
Date received
2020-03-30
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MS. CYNTHIA THAI
Address
1911 WALKER AVENUE MONROVIA, CA US
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1IMPLANTABLE COLLAMER LENS (ICL)PHAKIC TORIC INTRAOCULAR LENSSTAAR SURGICAL COMPANYQCBVTICMO13.2NAN/AR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-03-3001. R

Event Narratives#

N

Patient 1

THIS PRODUCT IS NOT MARKETED IN THE US. (B)(4).

D

Patient 1

THE REPORTER INDICATED THAT A 13.2MM, VTICMO13.2, -10.0/1.0/087 (SPHERE/CYLINDER/AXIS) IMPLANTABLE COLLAMER LENS WAS IMPLANTED INTO PATIENTS RIGHT EYE (OD) ON (B)(6) 2019. ON (B)(6) 2019 THE LENS WAS EXCHANGED FOR A SHORTER LENGTH LENS DUE TO EXCESSIVE VAULT. THIS EXCHANGE RESOLVED THE PROBLEM.