BEUDAMED
    FDA Adverse Event Summary report: N

    ALLERGAN

    MDR report key: 2202198 · Received August 5, 2011

    Report

    Report Number
    MW5021683
    Date Received
    August 5, 2011
    Date of Event
    July 27, 2011
    Report Date
    August 5, 2011
    Manufacturer
    AMO SALES & SERVICE, INC
    Product Code
    HQC
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    BIOMEDICAL ENGINEER

    Narratives

    Description of Event or Problem · 1

    COMPLICATION OCCURRED DURING EYE SURGERY. PROBLEMS ASSOCIATED WITH THE COMPLICATIONS ARE UNDETERMINED AT THIS TIME. USER ERROR VS EQUIPMENT MALFUNCTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ALLERGAN PHACO UNIT HQC AMO SALES & SERVICE, INC ALLERGAN SOVEREIGN W

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR