MAUDE Adverse Event Report: CARL ZEISS MEDITEC PRODUCTION LLC CT LUCIA 602

Model Number	602
Medical Device Problem Code	Use of Device Problem (1670)
Health Effect - Clinical Code	Visual Impairment (2138)
Date of Event	06/13/2023
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
The device has not been sent back.Thus, a proper device analysis could not be completed.Based on the information provided, the risk assessment for the lucia product and based on our experience and other complaints that have already been resolved, we have determined that the following factors may have cause or contributed to the reported issue are known to be caused by numerous factors including, but not limited to: loading strategy.Lens placement technique.Accessory device support.Poor handling during folding and inserting.Risk assessment has been reviewed within the technical file for the 3pc hydrophobic lenses.Risk assessment identifies damage of the iol haptic due to improper handling, implantation techniques, or use of inappropriate surgical instrument.This is seen as reasonably foreseeable misuse which may result in additional surgery because of impaired vision or potential iol explantation.The severity of damage is seen as a serious event that may result in injury or disability which requires surgical intervention, the likelihood of occurrence is estimated to be occasional.The result is deemed acceptable.The device history records were reviewed and there were no non-conformities or deviations noted during the manufacturing of the lens that would have caused or contributed to the nature of this complaint.Additionally, our lenses are 100% inspected before they leave our manufacturing site.Therefore, we are confident that the lens was processed per standard operating procedures and inspections and met all criteria for release.
Event or Problem Description
It was reported that the haptic was damaged.The lens was explanted, a second lens was used to complete the procedure during another surgery.
Additional Manufacturer Narrative
Field d9: updated to "yes" field g3: updated "date received by manufacturer" field g6: updated to "follow-up # 1" and "30-day" field h2: selected "correction, and device evaluation" field h3: updated to "yes".Checked "evaluation summary attached" box field h6: added type of investigation to "10".Field h10: added description of changes.

• Brand Name: CT LUCIA 602
• Common Device Name: CT LUCIA 602
• Manufacturer (Section D): CARL ZEISS MEDITEC PRODUCTION LLC; 1040 s vintage ave. bld. a; ontario CA 91761
• Manufacturer (Section G): CARL ZEISS MEDITEC PRODUCTION LLC; 1040 s vintage ave. bld. a; ontario CA 91761
• Manufacturer Contact: manjaya hegde ; 5300 central parkway; dublin, CA 94568 ; 9252164697
• MDR Report Key: 17289666
• Report Number: 3010126268-2023-00088
• Device Sequence Number: 17729286
• Product Code: HQL
• UDI-Device Identifier: 00843045100980
• UDI-Public: (01)00843045100980(17)260228
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: P10016-S008
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2023
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 08/04/2023

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 Expiration Date: 02/28/2026
• Device Model Number: 602
• Device Catalogue Number: 003500-0050-677
• Device Lot Number: 3S210262
• 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: 06/13/2023
• Supplement Date Received by Manufacturer: 07/20/2023
• Initial Report FDA Received Date: 07/10/2023
• Supplement Report FDA Received Date: 08/04/2023
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 03/15/2021
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Unknown