MAUDE Adverse Event Report: JOHNSON & JOHNSON SURGICAL VISION, INC. EMERALD; SURGICAL ADJUNCTS

Model Number 1CART30

Device Problem Material Deformation (2976)

Patient Problem No Patient Involvement (2645)

Event Date 06/25/2019

Event Type  malfunction  

Manufacturer Narrative

If implanted, if explanted, give date: not applicable, the cartridge is not an implantable device.Email address: unknown/not provided.Attempts have been made to obtain missing information; however, no definitive response has been received.All pertinent information available to johnson & johnson surgical vision, inc.Has been submitted.

Event Description

It was reported that there were 3 cartridges that appeared to have a sharp/warped, and melted tips, upon attempted implantation, the leading haptic broke/sheared off by the cartridge.There was no patient contact.No additional information provided.This report is for #3 of the 3 reported events.A separate report is being submitted for each of the 3 cartridges.

Manufacturer Narrative

Device evaluation: product testing could not be performed because the product was not returned.The reported complaint was not confirmed.Manufacturing record review: the manufacturing process record was evaluated and no deviation was found during process related to the complaint issue reported.Conclusion: as a result of the investigation, there is no indication of a product quality deficiency.All pertinent information available to johnson and johnson surgical vision has been submitted.

Manufacturer Narrative

Upon further review it was noted that the initial mdr had the incorrect aware date of 6/25/19.Therefore, this supplemental filing is to correct the aware date to 6/26/19.All pertinent information available to johnson & johnson surgical vision, inc.Has been submitted.

Manufacturer Narrative

This correction mdr is being submitted to address inaccurate information in section f on the xml version of the previous submission caused by a software glitch in the transmission process.The internal non-conformance numbers for this software issue are (b)(4) and capa-010215.

• Brand Name: EMERALD
• Type of Device: SURGICAL ADJUNCTS
• Manufacturer (Section D): JOHNSON & JOHNSON SURGICAL VISION, INC.; 1700 e st andrew place; santa ana CA 92705
• MDR Report Key: 8825027
• MDR Text Key: 152216023
• Report Number: 2648035-2019-00762
• Device Sequence Number: 1
• Product Code: KYB
• UDI-Device Identifier: 05050474534469
• UDI-Public: (01)05050474534469(17)200124(10)CE00903
• Combination Product (y/n): Y
• PMA/PMN Number: K961242
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,health
• Type of Report: Initial,Followup,Followup,Followup
• Report Date: 01/01/2005,11/12/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 01/24/2020
• Device Model Number: 1CART30
• Device Catalogue Number: 1CART30
• Device Lot Number: CE00903
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Date Report Sent to FDA: 01/01/2005
• Date Report to Manufacturer: 01/10/2005
• Initial Date Manufacturer Received: 06/25/2019
• Initial Date FDA Received: 07/25/2019
• Supplement Dates Manufacturer Received: 08/16/2019; 09/12/2019; 10/25/2020
• Supplement Dates FDA Received: 08/23/2019; 10/07/2019; 11/13/2020
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Treatment: ZCB00 LENS SN:UNKNOWN; ZCB00 LENS SN:UNKNOWN