MAUDE Adverse Event Report: ALCON RESEARCH, LLC - IRVINE TECHNOLOGY CENTER CENTURION VISION SYSTEM; UNIT, PHACOFRAGMENTATION

Catalog Number 8065751763

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Hypopyon (1913); Vitritis (2181); Toxic Anterior Segment Syndrome (TASS) (4469)

Event Date 04/16/2021

Event Type  Injury  

Manufacturer Narrative

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.This is the second of four reports for this reported event.The manufacturer internal reference number is: (b)(4).

Event Description

A physician reported that after a cataract surgery, a patient experienced toxic anterior segment syndrome (tass).Additional information has been requested and received indicating additional suspect products and patient identifier.This report represents patient 2 of 3 from this facility.Additional information received indicated that the tass symptoms were noted on first post-operative day.The patient was not hospitalized as a result of this event and was not on medications/therapies in use at the time of the event.The patient developed vitritis and hypopyon as complications of the event.The patient required treatment with tobramycin/dexamethasone every hour.There were no surgical complications and no sutures were not required for this event.No cultures were taken.The event was ongoing at the time of this report.

Manufacturer Narrative

Additional information is provided in h.3, h.6 and h.10.No further information was able to be obtained from this customer.With no additional, related information provided, the customers reported event was not able to be confirmed.The manufacturing device history record (dhr) was reviewed.Based on qa assessment, the product met specifications at the time of release.Based on the information obtained, the root cause of the reported event cannot be determined conclusively.The manufacturer will continue to monitor data for evidence of adverse trending and take further action, as appropriate.The manufacturer internal reference number is: (b)(4).

• Brand Name: CENTURION VISION SYSTEM
• Type of Device: UNIT, PHACOFRAGMENTATION
• Manufacturer (Section D): ALCON RESEARCH, LLC - IRVINE TECHNOLOGY CENTER; 15800 alton parkway; irvine CA 92618
• MDR Report Key: 11866356
• MDR Text Key: 252212277
• Report Number: 2028159-2021-00518
• Device Sequence Number: 1
• Product Code: HQC
• UDI-Device Identifier: 00380657517633
• UDI-Public: 00380657517633
• Combination Product (y/n): N
• PMA/PMN Number: K121555
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,foreig
• Type of Report: Initial,Followup
• Report Date: 09/28/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Catalogue Number: 8065751763
• Device Lot Number: ASKU
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 04/30/2021
• Initial Date FDA Received: 05/21/2021
• Supplement Dates Manufacturer Received: 09/03/2021
• Supplement Dates FDA Received: 09/28/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Treatment: BETADINE.; INDOCOLLYZE.
• Patient Outcome(s): Other; Required Intervention
• Patient Age: 86 YR