MAUDE Adverse Event Report: RXSIGHT INC. LIGHT DELIVERY DEVICE (LDD)

Model Number	61002
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Uveitis (2122)
Date of Event	11/27/2024
Type of Reportable Event	Serious Injury
Event or Problem Description
A site reported to rxsight that on (b)(6) 2024, 1 week following the lock-in light treatment, the patient was prescribed antiviral medication to treat herpes zoster ophthalmicus (hzo).Topical steroid was subsequently added to treat an associated uveitis.Symptoms were resolved on (b)(6) 2025, and the patient proceeded to complete the final lock-in light treatment.
Additional Manufacturer Narrative
The device history record was reviewed and there were no discrepancies or unusual findings.The manufacturer's reference #: (b)(4).

• Brand Name: LIGHT DELIVERY DEVICE (LDD)
• Common Device Name: LIGHT DELIVERY DEVICE (LDD)
• Manufacturer (Section D): RXSIGHT INC.; 100 columbia; aliso viejo CA 92656
• Manufacturer (Section G): RXSIGHT INC.; 100 columbia; aliso viejo CA 92656
• Manufacturer Contact: jim zhang ; 100 columbia; aliso viejo, CA 92656 ; 9492736163
• MDR Report Key: 22194530
• Report Number: 3012712027-2025-00177
• Device Sequence Number: 13196370
• Product Code: PZK
• UDI-Device Identifier: 00818806020029
• UDI-Public: 010081880602002911221231
• Combination Product (Y/N): N
• Initial Reporter State: LA
• Initial Reporter Country: US
• PMA/510(K) Number: P160055
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional,User Facility,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 06/12/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Health Professional
• Device Model Number: 61002
• Device Catalogue Number: 61002
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/14/2025
• Initial Report FDA Received Date: 06/12/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 12/31/2022
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Unknown