Brand Name | ICL (IMPLANTABLE COLLAMER LENS) |
Type of Device | INTRAOCULAR LENS |
Manufacturer (Section D) |
STAAR SURGICAL COMPANY |
haupstrasse 104 |
nidau, 2560 |
SZ 2560 |
|
Manufacturer (Section G) |
STAAR SURGICAL COMPANY |
haupstrasse 104 |
|
nidau, 2560 |
SZ
2560
|
|
Manufacturer Contact |
cynthia
thai
|
1911 walker avenue |
monrovia, ca
|
3037902237
|
|
MDR Report Key | 6541708 |
MDR Text Key | 201334669 |
Report Number | 2023826-2016-01557 |
Device Sequence Number | 1 |
Product Code |
QCB
|
Combination Product (y/n) | N |
PMA/PMN Number | NA |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Other,Foreign,Health Professional,Distributor |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
10/18/2016 |
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 Expiration Date | 11/30/2016 |
Device Model Number | VTICMO13.2 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
10/18/2016
|
Initial Date FDA Received | 05/03/2017 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 12/12/2013 |
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 |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 25 YR |
|
|