MAUDE Adverse Event Report: ALCON RESEARCH, LLC - HOUSTON CONSTELLATION SURGICAL PROCEDURE PAK; GENERAL SURGERY TRAY (KIT)

Catalog Number 8065751155

Device Problem Suction Failure (4039)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 03/26/2021

Event Type  malfunction  

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.The manufacturer internal reference number is: (b)(4).

Event Description

A customer reported that aspiration was not available during a procedure.The product was replaced and procedure completed with no patient harm.

Manufacturer Narrative

A review of the device history record traceable to the reported lot number, indicates that the product was processed and released according to the product¿s acceptance criteria.The customer reported, that the cassette had aspiration failure.The used infusion manifold in the pouch was visually inspected.And no obvious defects were found.The sample was tested in the returned condition with the lab stock constellation combined components using the console.The sample primed and passed intra ocular pressure (iop) calibration successfully.No system message code appeared on the screen.Fluid flowed from the balanced salt solution( bss) bottle to the drain bag without any interfering.No air leak was detected from the infusion air line, during priming process.No message code appeared on the screen.No leakage was found from the pump elastomer or onto the pump area of the fluidics module.Cleaning process was able to be performed after functional test was completed.The sample passed functionality.The root cause of the customer's complaint could not be established, as the returned (fms) fluidics management system cassette was evaluated and met specifications.After investigation of this complaint, it has been determined, that this sample functioned per specifications.Therefore, no corrective action is required at this time.Quality assurance has reviewed this complaint.And will continue to monitor data for evidence of adverse trending and take further action, as appropriate.Consumables manufacturing management has been made aware of this complaint through the consumer affairs review meeting.The manufacturer internal reference number is: (b)(4).

• Brand Name: CONSTELLATION SURGICAL PROCEDURE PAK
• Type of Device: GENERAL SURGERY TRAY (KIT)
• Manufacturer (Section D): ALCON RESEARCH, LLC - HOUSTON; 9965 buffalo speedway; houston TX 77054
• MDR Report Key: 11655664
• MDR Text Key: 245101802
• Report Number: 1644019-2021-00246
• Device Sequence Number: 1
• Product Code: LRO
• UDI-Device Identifier: 00380657511556
• UDI-Public: 380657511556
• Combination Product (y/n): N
• PMA/PMN Number: K880961
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: foreign,health professional
• Type of Report: Initial,Followup
• Report Date: 05/21/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 04/13/2021
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 05/31/2022
• Device Catalogue Number: 8065751155
• Device Lot Number: 2390763H
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 04/22/2021
• Date Manufacturer Received: 05/18/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Treatment: CONSTELLATION VISION SYSTEM; CONSTELLATION VISION SYSTEM