MAUDE Adverse Event Report: HOYA SURGICAL OPTICS, INC. PREVUE C; INTRAOCULAR LENS

Model Number PREVUE C (+15.00 D)

Device Problem Sharp Edges (4013)

Patient Problems Failure of Implant (1924); Capsular Bag Tear (2639)

Event Date 03/29/2023

Event Type  Injury  

Manufacturer Narrative

This initial emdr is being submitted to fda as a reportable event that occurred in the usa.Note: delayed emdr submission was due to fda esg webtrader account system software issues, per fda esg help desk ticket # 352650 (and subsequent ticket # 359662).Hoya due diligence is documented under internal issue-0807.Posterior capsule rupture is indicated as a potential adverse event related to iol implantation, as covered under the warnings section of the product's instructions for use (ifu).Regarding section h6 - manufacturer's codes for: type of investigation, findings, and conclusion are pending device return and completion of product investigation.Once the product investigation is completed, a follow-up report will be submitted to fda which will include the manufacturer's codes for type of investigation, findings, and conclusion.

Event Description

Intra-operative complications.Capsule rupture, explantation while inserting the lens, it tore the capsule.No incision enlargement; product replaced with another lens immediately during surgery.No permanent or negative impact on patient health expected.

Event Description

Intra-operative complications.Capsule rupture, explantation while inserting the lens, it tore the capsule.No incision enlargement; product replaced with another lens immediately during surgery.No permanent or negative impact on patient health expected.

Manufacturer Narrative

This follow-up #1 emdr is being submitted to fda for a reportable event that occurred inside of the usa.The report includes additional information not available/included in the initial report.H3 - indicated device not returned g6 - type of report - noted as follow-up #1 h2 - type of follow-up - noted for additional information h6 - added codes for manufacturer's investigation: type; findings; and conclusion.The product was not returned to the manufacturer.The investigation was conducted, with the methods and results as noted below.No abnormalities were found in production and inspection records of the product.(serial no.: (b)(6); model: prevue c) this case was reported that the used ovd is 'unknown'.The exact root cause of the event was not determined.However, based on available information, we believe this event was not caused by our product quality.A review of the most recent complaint trending data indicates that no significant trends have been identified at this time and no capa is required as part of the product evaluation.

• Brand Name: PREVUE C
• Type of Device: INTRAOCULAR LENS
• Manufacturer (Section D): HOYA SURGICAL OPTICS, INC.; 110 progress; suite 175; irvine CA 92618
• Manufacturer (Section G): HOYA MEDICAL SINGAPORE PTE LTD; 455a jalan ahmad ibrahim; singapore, singapore 63993 9; SN 639939
• Manufacturer Contact: goutham pendyala ; 110 progress; suite 175; irvine, CA 92618 ; 9093896317
• MDR Report Key: 17067451
• MDR Text Key: 316571733
• Report Number: 3006723646-2023-00061
• Device Sequence Number: 1
• Product Code: HQL
• UDI-Device Identifier: 10757770564061
• UDI-Public: 10757770564061
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: P080004
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative,Distributor
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 06/05/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 06/05/2023
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 12/31/2023
• Device Model Number: PREVUE C (+15.00 D)
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 04/11/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 12/31/2020
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention