FDA Adverse Event Malfunction Summary report: N

LAUREATE WORLD PHACO SYSTEM

MDR report key: 3022946 · Received March 20, 2013

Report

Report Number
2028159-2013-00441
Event Type
Malfunction
Date Received
March 20, 2013
Date of Event
February 22, 2013
Report Date
February 22, 2013
Manufacturer
ALCON - IRVINE TECHNOLOGY CTR
Product Code
HQC
PMA / PMN Number
K021566
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
BR
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

INVESTIGATION INCLUDING A ROOT CAUSE ANALYSIS IS IN PROGRESS. A SUPPLEMENTAL MDR WILL BE FILED AS NECESSARY IN ACCORDANCE WITH 21 CFR 803.56 WHEN ADD'L REPORTABLE INFO BECOMES AVAILABLE. (B)(4).

Description of Event or Problem · 1

A CUSTOMER REPORTED A PT HAD REC'D PERIBULBAR ANESTHESIA IN PREPARATION FOR SURGERY. THE PROCEDURE HAD NOT YET STARTED WHEN THE SYSTEM DISPLAYED A MESSAGE. FOOTSWITCH ISSUES, AND LOCKED. THE CASE WAS CANCELED. THERE WAS NO HARM TO THE PT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
116753 LAUREATE WORLD PHACO SYSTEM PHACOFRAGMENTATION SYSTEM HQC ALCON - IRVINE TECHNOLOGY CTR LAUREATE NA

Patients

Seq Age Sex Outcome Treatment
1 UNK