Brand Name | IMPLANTABLE COLLAMER LENS (ICL) |
Type of Device | PHAKIC INTRAOCULAR LENS |
Manufacturer (Section D) |
STAAR SURGICAL COMPANY |
1911 walker avenue |
monrovia, ca |
|
MDR Report Key | 10457347 |
MDR Text Key | 204542818 |
Report Number | 2023826-2020-01882 |
Device Sequence Number | 1 |
Product Code |
MTA
|
Combination Product (y/n) | N |
PMA/PMN Number | N/A |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
foreign,health professional,o |
Type of Report
| Initial,Followup |
Report Date |
07/30/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Expiration Date | 11/30/2022 |
Device Model Number | VICM5_13.2 |
Device Catalogue Number | N/A |
Device Lot Number | N/A |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 09/09/2020 |
Initial Date Manufacturer Received |
07/30/2020
|
Initial Date FDA Received | 08/26/2020 |
Supplement Dates Manufacturer Received | 10/22/2020
|
Supplement Dates FDA Received | 11/20/2020
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Treatment | CARTRIDGE MODEL-SFC-45, LOT#-UNK; FOAM TIP PLUNGER MODEL-FTP, LOT#-UNK; INJECTOR MODEL-MSI-PF, LOT#-UNK |
Patient Age | 29 YR |
|
|