MAUDE Adverse Event Report: HOYA SURGICAL OPTICS, INC. HOYA ISERT 250; INTRAOCULAR LENS

Model Number HOYA ISERT 250 (+23.00 D)

Device Problem Contamination /Decontamination Problem (2895)

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

Event Date 05/30/2021

Event Type  malfunction  

Manufacturer Narrative

This initial emdr is being submitted to fda for outside us like products reporting.Manufacturer's codes for patient health effects (clinical and impact), and device problem and component have been entered in this report.Manufacturer's codes for investigation type, findings and conclusion are pending the completion of the product investigation.Once the investigation is completed, a follow-up report will be submitted to fda which will include the manufacturer's codes for investigation type, findings and conclusion.

Event Description

Packaging problem; there is unknown debris at opening pouch.No patient involvement.The event occurred in (b)(6).There was no impact to the patient, however it was reported to the (b)(6) by the hospital.

Event Description

Packaging problem; there is unknown debris at opening pouch.No patient involvement the event occurred in china.There was no impact to the patient, however it was reported to the chinese authority by the hospital.

Manufacturer Narrative

This follow-up #1 emdr is being submitted to fda for a reportable event that occurred outside of the usa.The report includes corrected information and additional information not available/included in the initial report.Corrected information: h3 - device evaluated: corrected to yes additional information: d9 - added date returned product was received by manufacturer g6 - type of report - noted as follow-up #1 h2 - type of follow-up - noted for correction and additional information h6 - added codes for manufacturer's investigation: type; findings; and conclusion.The product was returned to the manufacturer.The investigation was conducted, with the methods and results as noted below.The appearance check result was not consistent with the reported information.No foreign matter or unknown debris was found on the product or in the returned pouch.Therefore, we were not able to confirm the reported event.No abnormalities were found in production and inspection records of the product.(serial no.: (b)(6); model: 250).In addition, research in our complaint database indicated there were not any similar complaints in the same production lot.The exact root cause was not determined.However, 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: HOYA ISERT 250
• Type of Device: INTRAOCULAR LENS
• Manufacturer (Section D): HOYA SURGICAL OPTICS, INC.; 15335 fairfield ranch rd.; suite 250; chino hills CA 91709
• MDR Report Key: 12136909
• MDR Text Key: 273769101
• Report Number: 3006723646-2021-00052
• Device Sequence Number: 1
• Product Code: HQL
• UDI-Device Identifier: 04547480480848
• UDI-Public: 04547480480848
• Combination Product (y/n): N
• PMA/PMN Number: P080004
• 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: 06/15/2021

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: 12/31/2023
• Device Model Number: HOYA ISERT 250 (+23.00 D)
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 08/26/2021
• Initial Date Manufacturer Received: 06/15/2021
• Initial Date FDA Received: 07/08/2021
• Supplement Dates Manufacturer Received: 06/15/2021
• Supplement Dates FDA Received: 09/14/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1