| Brand Name | THOR PHOTOMEDICINE LTD |
| Common Device Name | 810NM 1W CLUSTER (5X200MW) ISSUE 1 |
| Manufacturer (Section D) |
| THOR PHOTOMEDICINE LTD |
| units 1 & 2 anglo office park |
| white lion road |
| amersham, buckinghamshire HP7 9 FB |
| UK HP7 9FB |
|
| Manufacturer (Section G) |
| THOR PHOTOMEDICINE LTD |
| units 1 & 2 anglo office park |
| white lion road |
| amersham, buckinghamshire HP7 9 FB |
|
UK
HP7 9FB
|
|
| Manufacturer Contact |
|
ian
clinch
|
| units 1 & 2 anglo office park |
| white lion road |
| amersham, buckinghamshire HP7 9-FB
|
|
UK
HP7 9FB
|
|
| MDR Report Key | 18918774 |
| Report Number | 3003899624-2024-00003 |
| Device Sequence Number | 6892748 |
| Product Code |
ILY
|
| UDI-Device Identifier | 05060494130145 |
| UDI-Public | (01)05060494130145 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | NO |
| PMA/510(K) Number | K033923 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,User Facility |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
03/15/2024 |
| 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
|
| Operator of Device |
Health Professional
|
| Device Model Number | S1160 |
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Initial |
| Initial Date Received by Manufacturer | Not provided |
| Initial Report FDA Received Date | 03/15/2024 |
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Is the Device Labeled for Single Use? (Y/N) |
No
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Reuse
|
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |