MAUDE Adverse Event Report: JOHNSON & JOHNSON SURGICAL VISION, INC. SENSAR; MONOFOCAL IOLS

Model Number	AR40M
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Additional information: breakdown of the 5 events of is as follows: iol torn 1.Haptic damaged, improperly loaded 1.Haptic damaged 3.Serial numbers of suspect products: (b)(4).1 investigation was completed and 4 are pending from the period.From the 1 investigation: 1 haptic was damage and lens was cut.In the investigation it was concluded that products met manufacturing release criteria and no product deficiency was identified.A review of records related to the device including labeling, complaint trending, and risk documentation will be performed.Upon completion of this review, if there is any further relevant information obtained, a supplemental medwatch will be file.All pertinent information available to johnson & johnson surgical vision, inc.That was received during the time period that covers this voluntary malfunction summary report has been submitted.
Event or Problem Description
This report summarizes 5 malfunction events.The events were related to lens damaged.There were no patient injuries reported associated to the events.
Additional Manufacturer Narrative
This correction mdr is being submitted to address inaccurate information in section f and g.4 date on the xml version of the previous submission caused by a software glitch in the transmission process.The internal non-conformance numbers for this software issue are (b)(4) and capa-(b)(4).
Additional Manufacturer Narrative
Additional information: there were 3 investigations completed during this period and the products were returned.Breakdown of 3 investigations with respective serial numbers are as follows: (b)(4) haptic detached.(b)(4) haptic detached.(b)(4) lens cut, haptic detached.The investigation it concluded that product met manufacturing release criteria and no product deficiency was identified.All pertinent information available to johnson & johnson surgical vision, inc.That was received during the time period that covers this voluntary malfunction summary report has been submitt h3 other text : placeholder.
Additional Manufacturer Narrative
Correction: the number of events (noe) from previous quarter ((b)(6) 2019 to (b)(6) 2019) was initially reported as 5 however, it was found the correct noe is 4.1 event with serial number (b)(4) was inadvertently reported under this model ar40m instead of correct model ar40e with mfr report number 2648035-2019-01137.Further information for this serial number will be reported under model ar40e with mfr report number 2648035-2019-01136.All pertinent information available to johnson & johnson surgical vision, inc.That was received during the time period that covers this voluntary malfunction summary report has been submitted.H3 other text : placeholder.

• Brand Name: SENSAR
• Common Device Name: MONOFOCAL IOLS
• Manufacturer (Section D): JOHNSON & JOHNSON SURGICAL VISION, INC.; 1700 e st andrew place; santa ana CA 92705
• MDR Report Key: 9247855
• Report Number: 2648035-2019-01137
• Device Sequence Number: 3107955
• Product Code: HQL
• UDI-Device Identifier: 05050474514249
• UDI-Public: (01)05050474514249
• Combination Product (Y/N): Y
• PMA/510(K) Number: P980040
• Number of Events Summarized: 5
• Summary Report (Y/N): Y
• Reporter Type: Manufacturer
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup,Followup,Followup
• Report Date (Section B): 10/28/2020
• 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?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: No Information
• Device Model Number: AR40M
• Device Catalogue Number: AR40MN0025
• Was the Report Sent to FDA?: No
• Date Report to Manufacturer: 01/10/2005
• Initial Date Received by Manufacturer: 01/14/2005
• Supplement Date Received by Manufacturer: 01/14/2005; 01/14/2005; 10/25/2020
• Initial Report FDA Received Date: 10/28/2019
• Supplement Report FDA Received Date: 01/29/2020; 01/30/2020; 10/28/2020
• Patient Sequence Number: 1
• Date Report Sent to FDA: 01/01/2005