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Additional information was provided in d.9., h.3., h.6.And h.11.The device was returned in the blister tray inside the carton.The plunger lock and lens stop had been removed.The plunger was oriented correctly.Inadequate viscoelastic was observed in the device.The plunger was retracted to mid-nozzle.The nozzle tip had an aneurysm on the bottom center.The nozzle was removed and cleaned for further evaluation.Top coat dye stain testing was conducted with acceptable results.A device history record review and a non-conformance review of the reported lot number was conducted.The deviation review did not reveal any potential contributing factors to the reported complaint and all corresponding production release specifications defined in the device master record were met.Viscoelastic was not provided.It is unknown if a qualified viscoelastic was used.The lens was not returned in the device.The root cause for the reported issue appeared to be related to a failure to follow the instructions for use (ifu).Inadequate viscoelastic was observed in the device.It is unknown if a qualified viscoelastic was used.The nozzle tip had an aneurysm bottom center.This damage would indicate the lens/plunger were not in an acceptable position for advancement.The ifu instructs: during device preparation and implantation of the company intraocular lens (iol) with the company preloaded delivery system, a company qualified ophthalmic viscoelastic device (ovd) should be used.The use of an unqualified ovd may cause damage to the lens and potential complications during the device preparation and implantation steps.The ifu instructs: fully insert the ovd cannula, perpendicular to the device, through the viscoelastic port, located in the lens stop portion of the device.Fill the device until ovd can be observed flowing to the "fill-to" line on the nozzle tip.This will require approximately 0.2 milliliters (ml) of ovd.Only use a company ovd qualified for use with the company pre-loaded delivery system that has been allowed to come to the operating room temperature.If inadequate viscoelastic is placed in the device this will cause inadequate coverage of the lens fold path which may cause the lens to advance incorrectly or become "stuck" in the device.The ifu instructs: after the lens has been advanced to the nozzle line, the lens should be visually inspected to determine the position of the haptics.The plunger should be in contact with the trailing optic edge.After confirming the lens is properly positioned and the haptics are folded properly, proceed with lens implantation.Proceeding with implantation of a misfolded haptic or a lens that appears to be "out of position" can result in a broken haptic or other negative outcome, since the haptic may be trapped and stretched, and/or pinched and sheared by the moving plunger.The manufacturer internal reference number is: (b)(4).
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