MAUDE Adverse Event Report: MEDLINE INDUSTRIES LP; DBD-CATARACT EYE PACK

Catalog Number DYNJ81664

Device Problem Material Integrity Problem (2978)

Patient Problem Foreign Body In Patient (2687)

Event Date 03/08/2023

Event Type  Injury  

Manufacturer Narrative

It was reported that a patient had a phacoemulsification with pc iol with istent placement on (b)(6) 2023.On (b)(6) 2023, removal of foreign body (white thread) was removed in the or.No additional details were provided.A sample was requested to be returned for evaluation.It has been determined that the reported event caused or contributed to serious injury, therefore, this medwatch is being filed.If any further relevant information is identified or obtained, a supplemental medwatch will be submitted.

Event Description

A white thread was removed from the eye following a phacoemulsification.

• Type of Device: DBD-CATARACT EYE PACK
• Manufacturer (Section D): MEDLINE INDUSTRIES LP; three lakes drive; northfield IL 60093
• Manufacturer Contact: kelly zampella ; three lakes drive; northfield, IL 60093
• MDR Report Key: 17613418
• MDR Text Key: 321856065
• Report Number: 1423395-2023-00038
• Device Sequence Number: 1
• Product Code: OJK
• UDI-Device Identifier: 10195327135829
• UDI-Public: 10195327135829
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 08/24/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/24/2023
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Catalogue Number: DYNJ81664
• Device Lot Number: 23DDA989
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 07/28/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Patient Outcome(s): Other