BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BOWMAN LACRIMAL PROBE DOUBLE-ENDED, STAINLESS STELL 5-1/8"

    MDR report key: 11744582 · Received April 28, 2021

    Report

    Report Number
    MW5101071
    Event Type
    Injury
    Date Received
    April 28, 2021
    Date of Event
    April 23, 2021
    Report Date
    April 27, 2021
    Product Code
    HNL
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    LACRIMAL PROBE BROKE DURING USE LEAVING A SMALL LINEAR MENTAL FRAGMENT THAT HAD TO BE REMOVED IN 2ND SURGERY. FDA SAFETY REPORT ID# (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    638595 BOWMAN LACRIMAL PROBE DOUBLE-ENDED, STAINLESS STELL 5-1/8" PROBE, LACHRYMAL HNL AZ1905

    Patients

    Seq Age Sex Outcome Treatment
    1 43 YR Required Intervention