MAUDE Adverse Event Report: HOYA SURGICAL OPTICS, INC. PREVUE C; INTRAOCULAR LENS

Model Number PREVUE C (+23.00 D)

Device Problem Sharp Edges (4013)

Patient Problem Capsular Bag Tear (2639)

Event Date 10/06/2022

Event Type  Injury  

Manufacturer Narrative

This initial emdr is being submitted to fda as a reportable event that occurred in the usa."posterior capsule rupture" is indicated as a potential adverse event related to iol implantation in hoya ifu covered under the warnings section.Type of investigation, findings, and conclusion are pending device return and completion of product investigation.Once the product investigation is completed, a follow-up report will be submitted to fda which will include the manufacturer's codes for type of investigation, findings, and conclusion.

Event Description

Intra-operative complications: lens was implanted then explanted due to lens decentered because of posterior capsule tear.

Manufacturer Narrative

This follow-up #1 emdr is being submitted to fda for a reportable event that occurred inside of the usa.The report includes corrected information and additional information not available/included in the initial report.Corrected information: corrected to yes.Additional information: added date returned indicated company representative for investigation type of report - noted as follow-up #1 type of follow-up - noted for corrected information and additional information 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.We couldn't confi rm reported event but we found the iol was damaged.No abnormalities were found in production and inspection records of the product.(serial no.: (b)(6); model: prevue c).The exact root cause of the event was not determined.However, based on available information, 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.

Event Description

Intra-operative complications: lens was implanted then explanted due to lens decentered because of posterior capsule tear.

• Brand Name: PREVUE C
• Type of Device: INTRAOCULAR LENS
• Manufacturer (Section D): HOYA SURGICAL OPTICS, INC.; 525 technology drive; suite 280; irvine CA 92618
• Manufacturer (Section G): HOYA MEDICAL SINGAPORE PTE LTD; 455a jalan ahmad ibrahim; singapore, singapore 63993 9; SN 639939
• Manufacturer Contact: goutham pendyala ; 525 technology drive; suite 280; irvine, CA 92618 ; 9093896317
• MDR Report Key: 15756451
• MDR Text Key: 303278804
• Report Number: 3006723646-2022-00155
• Device Sequence Number: 1
• Product Code: HQL
• UDI-Device Identifier: 10757770564214
• UDI-Public: 10757770564214
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: P080004
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative,Distributor
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 10/20/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 11/08/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 11/30/2023
• Device Model Number: PREVUE C (+23.00 D)
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 10/20/2022
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 11/30/2020
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention