MAUDE Adverse Event Report: NIDEK CO. LTD. YC-200 S PLUS; YAG LASER

Model Number	YC-200
Medical Device Problem Code	Unexpected Therapeutic Results (1631)
Health Effect - Clinical Code	Appropriate Clinical Signs, Symptoms and Conditions Term/Code Not Available (4581)
Date of Event	04/25/2022
Type of Reportable Event	Malfunction
Event or Problem Description
On (b)(6) 2022, nidek inc.Service manager received a telephone call from nidek inc sales representative to report that the customer reported pitting lens.A followup was done by nidek inc service manager to speak with the doctor and confirmed that she has been having some issues with pitting lens, no injury reported.The device evaluation was completed at the customer site on (b)(6) 2022 per customer service order #(b)(4) by nidek inc field service engineer.Nidek inc.Considers pitting lens issue a reportable event as it is an undesirable condition and has the potential to cause or contribute to a serious injury if the issue were to recur.During the visit, customer informed fse following: on (b)(6) 2022, lens pitted 4 times with 24 shots emitted with a setting of 1.3mj power output and 250 posterior.On (b)(6) 2022, lens pitted once with 48 shots emitted with a setting of 1.0mj power output and 275 posterior.Mode: single.Magnification: 20x.Total shot count: 7544.Date of manufacture of yc-200 s plus s/n.(b)(4): (b)(6) 2021.Technical background: the ophthalmic yag laser system yc-200 consists of a slit lamp and the yag laser and is indicated for the performance of posterior capsulotomy, pupillary membranectomy, iridotomy (hole in the iris) and selective laser trabeculoplasty.This device uses passive q-switching for laser oscillation.With passive q-switching, the device first accumulates sufficient energy within the laser cavity then emits laser pulses of high peak power for extremely short durations by use of the q-switched optical element which changes between transparent and opaque according to the accumulation of energy.Yc-200 device is equipped with yag mode function only.Yc-200 s plus device is equipped with yag and slt mode functions.
Additional Manufacturer Narrative
Nidek inc.Determined that the cause of customer reported issue "pitting lens" was inconclusive.The system was tested and inspected.Nidek inc field service engineer (fse) verified that the system is operational.The reported unit passed final inspection per inspection distribution acceptance record# (b)(4), and installation and in-service training was performed properly per installation/in-service record# (b)(4).There was no supporting evidence to point to machine, man, and method/process and material as the cause of the reported complaint issue.As a precaution, fse installed foot pedal (part no.17330-0012) and replaced slide plate (part no.Yc020-m216).In addition, rg-093-2 yc-200/ yc-200 s plus quick reference guide will be sent out to the customer to remind customer of safety information in yc-200 operator's manual to mitigate against potential occurrence of pitting lenses.Device evaluation is completed and fse verified that the system is operational.

• Brand Name: YC-200 S PLUS
• Common Device Name: YAG LASER
• Manufacturer (Section D): NIDEK CO. LTD.; 34-14 hiroishi; gamagori, aichi 443-0 038; JA 443-0038
• Manufacturer (Section G): NIDEK CO. LTD.; 34-14 hiroishi; gamagori, aichi 443-0 038; JA 443-0038
• Manufacturer Contact: todd milholland ; 2040 corporate court; san jose, CA 95131 ; 4084686460
• MDR Report Key: 14459584
• Report Number: 0002936921-2022-00004
• Device Sequence Number: 4515847
• Product Code: HQF
• UDI-Device Identifier: 04987669101452
• UDI-Public: (01)04987669101452
• Combination Product (Y/N): N
• Initial Reporter State: AR
• Initial Reporter Country: US
• PMA/510(K) Number: K203130
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional,User Facility
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 05/19/2022

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
• Operator of Device: Health Professional
• Device Model Number: YC-200
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/26/2022
• Initial Report FDA Received Date: 05/20/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 02/03/2021
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Reuse
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other
• Patient Sex: Unknown