FDA Adverse Event Malfunction Summary report: N

ACCURUS 800CS

MDR report key: 1891081 · Received October 22, 2010

Report

Report Number
2028159-2010-02058
Event Type
Malfunction
Date Received
October 22, 2010
Date of Event
September 24, 2010
Report Date
September 24, 2010
Manufacturer
ALCON - IRVINE TECHNOLOGY CENTER
Product Code
HQC
PMA / PMN Number
K911808
Removal / Correction Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
TX, US
Reporter Occupation
BIOMEDICAL ENGINEER

Narratives

Additional Manufacturer Narrative · 1

THE FACILITY DID NOT REQUEST SERVICE. NO SAMPLES WERE RETURNED FOR EVAL. THERE WAS NO SAMPLE RETURNED FOR EVAL AND NO ADD'L INFO PROVIDED RELATED TO THIS EVENT. FOR THIS REASON, STEPS COULD NOT BE TAKEN TO REPLICATE OR CONFIRM THE REPORTED EVENT AND THE ROOT CAUSE IS, THEREFORE, UNK AT THIS TIME. (B)(4).

Description of Event or Problem · 1

THE CUSTOMER REPORTED LOW VACUUM DURING A CATARACT CASE. THE SYSTEM WAS SWITCHED OUT TO COMPLETE THE CASE. NO PT INJURY WAS REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 ACCURUS 800CS PHACOFRAGMENTATION SYSTEM HQC ALCON - IRVINE TECHNOLOGY CENTER ACCURUS NA

Patients

Seq Age Sex Outcome Treatment
1 UNK