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 2020-03-30 for IMPLANTABLE COLLAMER LENS (ICL) VICMO12.1 NA manufactured by Staar Surgical Company.
[186789431]
This product is not marketed in the us. (b)(4).
Patient Sequence No: 1, Text Type: N, H10
[186789432]
The reporter indicated that a 12. 1mm, vicmo12. 1, -8. 0 diopter, implantable collamer lens, was implanted into the patients right eye (od) on (b)(6) 2019. On (b)(6) 2019 the lens was exchanged for a longer length lens due to low vault. This exchange resolved the problem.
Patient Sequence No: 1, Text Type: D, B5
Report Number | 2023826-2020-00649 |
MDR Report Key | 9899346 |
Report Source | DISTRIBUTOR,FOREIGN,HEALTH PR |
Date Received | 2020-03-30 |
Date of Report | 2020-03-03 |
Date of Event | 2019-10-01 |
Date Mfgr Received | 2020-03-03 |
Device Manufacturer Date | 2019-02-26 |
Date Added to Maude | 2020-03-30 |
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 | 3 |
Manufacturer Contact | MS. CYNTHIA THAI |
Manufacturer Street | 1911 WALKER AVENUE |
Manufacturer City | MONROVIA, CA |
Manufacturer Country | US |
Manufacturer G1 | STAAR SURGICAL COMPANY |
Manufacturer Street | 1911 WALKER AVENUE |
Manufacturer City | MONROVIA, CA |
Manufacturer Country | US |
Single Use | 3 |
Previous Use Code | 3 |
Event Type | 3 |
Type of Report | 3 |
Brand Name | IMPLANTABLE COLLAMER LENS (ICL) |
Generic Name | PHAKIC INTRAOCULAR LENS |
Product Code | MTA |
Date Received | 2020-03-30 |
Model Number | VICMO12.1 |
Catalog Number | NA |
Lot Number | NA |
Operator | HEALTH PROFESSIONAL |
Device Availability | N |
Device Eval'ed by Mfgr | R |
Device Sequence No | 1 |
Device Event Key | 0 |
Manufacturer | STAAR SURGICAL COMPANY |
Manufacturer Address | 1911 WALKER AVENUE MONROVIA, CA US |
Patient Number | Treatment | Outcome | Date |
---|---|---|---|
1 | 0 | 1. Required No Informationntervention | 2020-03-30 |