FDA Adverse Event Malfunction Summary report: N

EVA

MDR report key: 15975279 · Received December 14, 2022

Report

Report Number
1222074-2022-00088
Event Type
Malfunction
Date Received
December 14, 2022
Date of Event
November 24, 2022
Report Date
February 7, 2023
Manufacturer
D.O.R.C. DUTCH OPHTHALMIC RESEARCH CENTER
Product Code
HQC
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
SP
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

IN REGARD TO THIS COMPLAINT, AN EVA VITRECTOMY MODULE WAS RETURNED FOR INVESTIGATION. INVESTIGATION OF THIS MODULE REVEALED THAT CUTTER VALVES INSIDE THE MODULE WERE STUCK DUE TO THE PRESENCE OF AN OIL-LIKE SUBSTANCE. DUE TO THE STUCK VALVES, THE MODULE COULD NOT FUNCTION WITHIN THE SPECIFICATIONS. THE ORIGIN OF THIS OIL-LIKE SUBSTANCE COULD NOT BE DETERMINED.

Additional Manufacturer Narrative · 0

THE COMPLAINT IS UNDER INVESTIGATION

Description of Event or Problem · 0

WE HAVE BEEN INFORMED THAT DURING PROCEDURE, THE HANDPIECE OF VITRECTOME DID NOT CUT. THE USER TRIED THREE VITRECTOMY PACKS FROM TWO DIFFERENT BATCHES AND THEY DID NOT SOLVE THE PROBLEM. THE USER STATES THAT THE VITRECTOMY MODULE SOUNDED WEIRD. THE USER WAS NOT ABLE TO SOLVE THE ISSUE AND IT WAS DECIDED TO ABORT THE SURGERY. NO REPORT THAT ACTUAL PATIENT HARM OCCURRED.

Description of Event or Problem · 0

WE HAVE BEEN INFORMED THAT DURING PROCEDURE, THE HANDPIECE OF VITRECTOME DID NOT CUT. THE USER TRIED THREE VITRECTOMY PACKS FROM TWO DIFFERENT BATCHES AND THEY DID NOT SOLVE THE PROBLEM. THE USER STATES THAT THE VITRECTOMY MODULE SOUNDED WEIRD. THE USER WAS NOT ABLE TO SOLVE THE ISSUE AND IT WAS DECIDED TO ABORT THE SURGERY. NO REPORT THAT ACTUAL PATIENT HARM OCCURRED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
474465 EVA EVA HQC D.O.R.C. DUTCH OPHTHALMIC RESEARCH CENTER

Patients

Seq Age Sex Outcome Treatment
1 Unknown