BEUDAMED
    FDA Adverse Event Other Summary report: N

    GALLERY G504

    MDR report key: 775365 · Received October 31, 2006

    Report

    Report Number
    MW1040854
    Event Type
    Other
    Date Received
    October 31, 2006
    Date of Event
    October 1, 2006
    Report Date
    October 31, 2006
    Manufacturer
    VET ADMINISTRATION
    Product Code
    HQZ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MS, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    VA EYE GLASSES HAD NOSE PADS OF PLASTIC THAT SMELLED AND IRRITATED SKIN. HAD OPTOMETRIST CHANGE PADS. THE PLASTIC DID NOT APPEAR CURED PROPERLY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 GALLERY G504 EYE GLASSES HQZ VET ADMINISTRATION * *

    Patients

    Seq Age Sex Outcome Treatment
    1 53 YR Other