BEUDAMED
    FDA Adverse Event Summary report: N

    *

    MDR report key: 2110639 · Received May 20, 2011

    Report

    Report Number
    2110639
    Date Received
    May 20, 2011
    Date of Event
    May 16, 2011
    Report Date
    May 20, 2011
    Manufacturer
    ALCON LABRATORIES, INC.
    Product Code
    NGY
    Report Source
    User Facility report
    Reporter Location
    CA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    A 25 GA TROCAR CANNULA WAS USED DURING VITRECTOMY PROCEDURE. THE TROCAR WAS REMOVED BY SURGICAL TIP AND IT WAS AT THIS TIME NOTED THAT THE TROCAR WAS BROKEN AND PART OF IT WAS RETAINED WITHIN THE VITREOUS SPACE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * 25 GA TROCAR CANNULA NGY ALCON LABRATORIES, INC. * *

    Patients

    Seq Age Sex Outcome Treatment
    1 88 YR