FDA Adverse Event
Malfunction
Summary report: N
CONSTELLATION VISION SYSTEM
MDR report key: 3190663
·
Received June 21, 2013
Report
- Report Number
- 2028159-2013-01222
- Event Type
- Malfunction
- Date Received
- June 21, 2013
- Date of Event
- May 1, 2013
- Report Date
- May 23, 2013
- Manufacturer
- ALCON - IRVINE TECHNOLOGY CENTER
- Product Code
- HQC
- PMA / PMN Number
- K101285
- Removal / Correction Number
- NA
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- UK
- Reporter Occupation
- OTHER
Narratives
Additional Manufacturer Narrative · 1
INVESTIGATION INCLUDING ROOT CAUSE ANALYSIS IS IN PROGRESS. A SUPPLEMENTAL MDR WILL BE FILED AS NECESSARY IN ACCORDANCE WITH 21 CFR 803.56 WHEN ADDITIONAL REPORTABLE INFORMATION BECOMES AVAILABLE. (B)(4).
Description of Event or Problem · 1
A HOSPITAL MANAGER REPORTED TO A COMPANY SALES REPRESENTATIVE THAT BUBBLES HAD BEEN SEEN WHILE USING 3 SYSTEMS OWNED BY THE FACILITY. THERE WAS NO PATIENT IMPACT REPORTED ADDITIONAL INFORMATION WAS REQUESTED. THIS IS ONE OF THREE REPORTS BEING FILED FOR THIS FACILITY.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 281911 | CONSTELLATION VISION SYSTEM | UNIT, PHACOFRAGMENTATION | HQC | ALCON - IRVINE TECHNOLOGY CENTER | LXT | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | UNK |