BEUDAMED
    FDA Adverse Event Other Summary report: N

    LENSAR LASER SYSTEM -FS 3D

    MDR report key: 4385914 · Received December 17, 2014

    Report

    Report Number
    3009026057-2014-00039
    Event Type
    Other
    Date Received
    December 17, 2014
    Date of Event
    December 1, 2014
    Report Date
    December 16, 2014
    Manufacturer
    LENSAR INC
    Product Code
    OOE
    PMA / PMN Number
    K120214
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    INVESTIGATION INCLUDING ROOT CAUSE ANALYSIS IS IN PROGRESS. A SUPPLEMENTAL MDR WILL BE FILED AS NECESSARY IN ACCORDANCE WITH 21 CFR 803. 56 WHEN ADDITIONAL REPORTABLE INFORMATION BECOMES AVAILABLE.

    Description of Event or Problem · 1

    CUSTOMER REPORTED THAT ON ONE CASE WITH DR. BENZ, THE SYSTEM REPORTED AN ERROR MESSAGE AND THE PROCEDURE HAD TO BE ABORTED DUE TO A LOSS OF SUCTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    829692 LENSAR LASER SYSTEM -FS 3D LENSAR LASER SYSTEM - FS 3D OOE LENSAR INC NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK Other