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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: STAAR SURGICAL COMPANY IMPLANTABLE COLLAMER LENS (ICL); PHAKIC INTRAOCULAR LENS

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STAAR SURGICAL COMPANY IMPLANTABLE COLLAMER LENS (ICL); PHAKIC INTRAOCULAR LENS Back to Search Results
Model Number MICL13.7
Medical Device Problem Code No Apparent Adverse Event (3189)
Health Effect - Clinical Code No Patient Involvement (2645)
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
Device evaluation: lens was returned in cartridge (sfc-45).Visual inspection found no visible damage to the device and residue on the device.Work order search: (b)(4) similar complaint type events were reported for units within the same lot.Claim #: (b)(4).
 
Event or Problem Description
The reporter indicated that 13.7mm micl13.7, -13.0 diopter, implantable collamer lens tore during loading.There was no patient contact and the backup lens was implanted with no problem.Cause of event was unknown.
 
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Brand Name
IMPLANTABLE COLLAMER LENS (ICL)
Common Device Name
PHAKIC INTRAOCULAR LENS
Manufacturer (Section D)
STAAR SURGICAL COMPANY
1911 walker avenue
monrovia CA 91016
MDR Report Key7680214
Report Number2023826-2018-01020
Device Sequence Number1409695
Product Code MTA
UDI-Device Identifier00841542103626
UDI-Public00841542103626
Combination Product (Y/N)N
Initial Reporter StatePA
Initial Reporter CountryUS
PMA/510(K) Number
P030016
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source health professional
Initial Reporter Occupation Other Health Care Professional
Type of Report Initial
Report Date (Section B) 06/13/2018
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Operator of Device Health Professional
Device Expiration Date07/31/2019
Device Model NumberMICL13.7
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer06/13/2018
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 06/13/2018
Initial Report FDA Received Date07/11/2018
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)
Yes
Patient Sequence Number1
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