BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SUPEREAGLE PUNCTUM PLUG

    MDR report key: 677272 · Received February 17, 2006

    Report

    Report Number
    1034718-2006-00008
    Event Type
    Injury
    Date Received
    February 17, 2006
    Date of Event
    December 12, 2005
    Report Date
    February 17, 2006
    Manufacturer
    EAGLE VISION, INC.
    Product Code
    LZU
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    REPORT REC'D ON 01/18/2006 OF PT EXPERIENCING PYOGENIC GRANULOMA OF LEFT UPPER PUNCTUM REQUIRING REMOVAL OF PLUG IN 2005.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SUPEREAGLE PUNCTUM PLUG PUNCTUM PLUG LZU EAGLE VISION, INC. 3130 72852

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other