MAUDE Adverse Event Report: AMO MANUFACTURING USA, LLC WHITESTAR SIGNATURE PRO; UNIT, PHACOFRAGMENTATION

Model Number NGP680301

Device Problems Use of Device Problem (1670); Suction Problem (2170)

Patient Problems Corneal Abrasion (1789); Appropriate Clinical Signs, Symptoms, Conditions Term / Code Not Available (4581)

Event Type  Injury  

Manufacturer Narrative

Additional narrative information: e1: telephone number: (b)(6).Device evaluation: the device was not returned at the manufacturing site; therefore, product testing could not be performed and the customer¿s reported complaint could not be verified.Manufacturing record review: a review of the records related to this equipment that included labeling, manual, trending, and risk documentation reviews was performed.Equipment labeling provides possible complications that can be caused by the surgical/treatment procedure being performed.The trend review shows that there is not a recognizable adverse trend.The risks and mitigation's associated with the complaint issue are identified in existing risk documents and no new risks were identified as part of this investigation.There was no product deficiency identified.Conclusion: based on the investigation results there is no indication of a product quality deficiency.All pertinent information available to johnson & johnson surgical vision, inc.Has been submitted.

Event Description

It was reported that customer found nuclear fragments remained in the anterior chamber during the post exams.Surgeon perceived that the vacuum performance during irrigation aspiration and phaco mode was bit low.The issue had occurred in three procedures since after the machine was checked on (b)(6) 2023.Reportedly transconjunctival single plane sclercorneal incision method was used with 2.75 mm incision size.There was no incision widened.Surgeon will perform secondary surgery to remove fragments with irrigation aspiration and is planned for end of (b)(6) 2023.Patient was prescribed with medication (levofloxacin, sanbetason).The patient outcome was reported as good visual acuity with no problems.The pack was reused for the patient.Additional information was received, and it was learnt that treatment date was (b)(6) 2023.Removal of residual nuclear fragment (post-spherical anesthesia).Bimanual irrigation aspiration (ia) was used and aspirated while shattering nuclear fragments with the tip.Nuclear fragment was aspirated without problems.Doctor mentioned that the corneal endothelial cell was decreased (1700 in this eye, 2000 in one eye), probably because it was a relatively large nucleus fragment.No particular problems with vision.This event will capture information for 3 of 3 patients.Other reports are being submitted for other patients.No further information was provided.

Manufacturer Narrative

At the time of initial filing following health effect impact code and clinical code was inadvertently missed, hence this is being added.Section h6: health effect-impact code ¿ 4625 for secondary surgical intervention: surgical intervention section h6: health effect-clinical code ¿ 1789 for striae in descemet's : corneal striae.All pertinent information available to johnson & johnson surgical vision, inc.Has been submitted.

• Brand Name: WHITESTAR SIGNATURE PRO
• Type of Device: UNIT, PHACOFRAGMENTATION
• Manufacturer (Section D): AMO MANUFACTURING USA, LLC; 510 cottonwood drive; milpitas CA 95035
• Manufacturer Contact: somyata nagpal ; 31 technology drive; irvine, CA 92618 ; 7142478552
• MDR Report Key: 16686976
• MDR Text Key: 312759179
• Report Number: 3012236936-2023-00816
• Device Sequence Number: 1
• Product Code: HQC
• UDI-Device Identifier: 05050474596146
• UDI-Public: (01)05050474596146
• Combination Product (y/n): N
• Reporter Country Code: JA
• PMA/PMN Number: K151636
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Health Professional,User Facility,Company Representative
• Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date: 05/18/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 04/05/2023
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: NGP680301
• Device Catalogue Number: NGP680301
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 04/24/2023
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 11/06/2020
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Reuse
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 74 YR
• Patient Sex: Female
• Patient Ethnicity: Non Hispanic
• Patient Race: Asian