BEUDAMED
    FDA Adverse Event Injury Summary report: N

    VISX EXCIMER LASER

    MDR report key: 2554500 · Received June 8, 2010

    Report

    Report Number
    3006695864-2010-00053
    Event Type
    Injury
    Date Received
    June 8, 2010
    Date of Event
    November 20, 2009
    Report Date
    May 11, 2010
    Manufacturer
    AMO MANUFACTURING USA, LLC
    Product Code
    LZS
    PMA / PMN Number
    K000327
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). SERVICE WAS NOT REQUESTED BY THE CLINIC FOR THIS ISSUE. CLINICAL DEVELOPMENT MANAGER AND AMO MEDICAL MONITOR DISCUSSED THE OUTCOMES WITH THE CLINIC. IT WAS DISCOVERED THAT THE SITE HAS TWO DOCTORS THAT WERE NOT CERTIFIED WITH THE USE OF THE VISX SYSTEM. CERTIFICATION TRAINING IS BEING SCHEDULED FOR THESE DOCTORS.

    Description of Event or Problem · 1

    THE CLINIC REPORTED THAT A PT WITH HIGH HYPEROPIA TREATED FOR AN I-SBK (SUB-BOWMANS KERATOMILEUSIS) LASER VISION CORRECTION IN BOTH EYES PRESENTED AT THE THREE MONTH POST-OPERATIVE EXAMINATION WITH A REFRACTION OF +.25 DIOPTER IN THE LEFT EYE (OS). THE PT WAS ALSO OBSERVED TO HAVE MICROSTRIAE IN THE OS EYE. THE PT'S POST-OP BCVA IS 20/30 SO AND UCVA IS 20/40 OS. THE PTS UCVA OU IS 20/25.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VISX EXCIMER LASER LZS AMO MANUFACTURING USA, LLC STAR

    Patients

    Seq Age Sex Outcome Treatment
    1 27 YR Other