Brand Name | BASIC VACUUM PHACO PACK |
Type of Device | UNIT, PHACOFRAGMENTATION |
Manufacturer (Section D) |
BAUSCH + LOMB |
rochester NY 14609 |
|
Manufacturer (Section G) |
BAUSCH + LOMB, INC. |
3365 treecourt industrial blvd |
|
st. louis MO 63122 |
|
Manufacturer Contact |
juli
moore
|
3365 tree court industrial blv |
st. louis, MO 63122
|
636226-322
|
|
MDR Report Key | 6552689 |
MDR Text Key | 74701200 |
Report Number | 0001920664-2017-00172 |
Device Sequence Number | 1 |
Product Code |
HQC
|
UDI-Device Identifier | 20757770057010 |
UDI-Public | (01)20757770057010(17)180325 |
Combination Product (y/n) | N |
Reporter Country Code | SN |
PMA/PMN Number | K063331 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
foreign,health professional,u |
Reporter Occupation |
Physician
|
Type of Report
| Initial,Followup,Followup |
Report Date |
04/13/2017 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 05/08/2017 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Physician
|
Device Expiration Date | 03/25/2018 |
Device Model Number | BL5110 |
Device Lot Number | V8157 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 05/19/2017 |
Is the Reporter a Health Professional? |
Yes
|
Date Manufacturer Received | 06/15/2017 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 10/25/2016 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
|
|