MAUDE Adverse Event Report: ABBOTT MEDICAL OPTICS TECNIS SYMFONY; MULTIFOCAL IOLS

Model Number	ZXR00
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Visual Impairment (2138); Halo (2227); No Code Available (3191)
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Date of event: unknown, not provided, but the best estimate date is between (b)(6).If explanted, give date: exact date is unknown; but reported as sometime in (b)(6) 2017.All pertinent information available to abbott medical optics has been submitted.
Event or Problem Description
A patient called and reported that she had a zxr00 24.5 diopter intraocular lens (iol) implanted in her operative eye on (b)(6) 2017.Post-operatively, she experienced a macular pucker and was not happy.She was unable to drive at night and saw halos around lights.Furthermore, she developed an epiretinal membrane after the initial implant and has been on prednisone since.Reportedly, she had the lens removed and replaced with a monofocal lens, which was performed by another doctor during (b)(6) of 2017.Post-operatively, the patient has no complaints about her vision with the new lens.The patient has been on anti-inflammatory medication since march.No additional information was provided.
Additional Manufacturer Narrative
Per account, the patient's affected eye is the right eye (od) and date of surgery was on (b)(6) 2017.Based on previous surgery on (b)(6) 2017, patient was complaining of having starbursts with bright lights, viewing rings in the multifocal lens, and trouble reading.Age/date of birth: (b)(6).All pertinent information available to johnson & johnson surgical vision, inc.Has been submitted.
Additional Manufacturer Narrative
Device evaluation: the product testing could not be performed as the product was not returned.The reported complaint cannot be confirmed.Manufacturing record review: the manufacturing process record was evaluated and no deviation was found during process related to the complaint issue reported.There was no discrepancy found during the mrr (manufacturing record review).The product was manufactured and released according to specifications.A search revealed that no similar complaints were received for this production order.Labeling review: the directions for use (dfu) was reviewed.The dfu adequately provides instructions and precautions for the proper use and handling of the product.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.

• Brand Name: TECNIS SYMFONY
• Common Device Name: MULTIFOCAL IOLS
• Manufacturer (Section D): ABBOTT MEDICAL OPTICS; santa ana CA 92705
• MDR Report Key: 7214439
• Report Number: 9614546-2018-00085
• Device Sequence Number: 1185885
• Product Code: POE
• UDI-Device Identifier: 05050474579187
• UDI-Public: (01)05050474579187(17)210907
• Combination Product (Y/N): Y
• Initial Reporter Country: US
• PMA/510(K) Number: P980040
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2017
• Reporter Type: Manufacturer
• Report Source: health professional,user faci
• Initial Reporter Occupation: Patient
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 07/24/2018
• Report Date (Section F): 01/01/2005

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: Physician
• Device Expiration Date: 09/07/2021
• Device Model Number: ZXR00
• Device Catalogue Number: ZXR00U0245
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: Yes
• Date Report to Manufacturer: 01/10/2005
• Initial Date Received by Manufacturer: 12/29/2017
• Supplement Date Received by Manufacturer: 06/01/2018; 06/29/2018
• Initial Report FDA Received Date: 01/23/2018
• Supplement Report FDA Received Date: 06/28/2018; 07/24/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 65 YR
• Date Report Sent to FDA: 01/01/2005