Brand Name | IMPLANTABLE COLLAMER LENS |
Type of Device | INTRAOCULAR LENS |
Manufacturer (Section D) |
STAAR SURGICAL COMPANY |
1911 walker avenue |
monrovia CA 91016 |
|
MDR Report Key | 11098631 |
MDR Text Key | 224530753 |
Report Number | 2023826-2020-03255 |
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 |
distributor,foreign,health pr |
Type of Report
| Initial,Followup |
Report Date |
12/08/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Expiration Date | 02/28/2023 |
Device Model Number | VICM5_12.6 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 12/18/2020 |
Initial Date Manufacturer Received |
12/08/2020 |
Initial Date FDA Received | 12/30/2020 |
Supplement Dates Manufacturer Received | 04/23/2021
|
Supplement Dates FDA Received | 05/20/2021
|
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 Outcome(s) |
Required Intervention;
|
Patient Age | 36 YR |
|
|