MAUDE Adverse Event Report: DUTCH OPTHALMIC RESEARCH CENTER BV DISPOSABLE HIGH SPEED CUTTER 20G/8000CPM

Catalog Number	8267.VIT20
Medical Device Problem Code	Device Operational Issue (2914)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	06/10/2015
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
This reportable event was identified during a voluntary retrospective review of all complaints since 2015 by the (b)(4).Assuming worst case during surgery, air bubbles observed at the probe.This may cause injury to the patient.Hence it is reportable.The risk is possible injury by microbial, viral or prion infection (patient harm).All available information has been provided.This complaint has now been closed.
Event or Problem Description
There was a bubble (silicone) on the vitretome while the patient`s eye had never had surgery before.The bubble did not come out of anything but was on the silicone from the start of vitrectomy.The bubble remained glued to vitrectomy throughout the procedure.All information has been disclosed.No sample.

• Brand Name: DISPOSABLE HIGH SPEED CUTTER 20G/8000CPM
• Common Device Name: DISPOSABLE HIGH SPEED CUTTER 20G/8000CPM
• Manufacturer (Section D): DUTCH OPTHALMIC RESEARCH CENTER BV; scheijdelveweg 2; zuidland, 3214V N; NL 3214VN
• MDR Report Key: 7498174
• Report Number: 1222074-2018-00104
• Device Sequence Number: 1949321
• Product Code: HQE
• UDI-Device Identifier: 08717872019109
• UDI-Public: 08717872019109
• Combination Product (Y/N): N
• Initial Reporter Country: FR
• PMA/510(K) Number: K142877
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: foreign,health professional,u
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 06/10/2015

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Physician
• Device Catalogue Number: 8267.VIT20
• Device Lot Number: 2000368509
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/10/2015
• Initial Report FDA Received Date: 05/09/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1