| Brand Name | Coolsculpting System |
| Common Device Name | Dermal cooling pack/vacuum/massager |
| Manufacturer (Section D) |
| Allergan (Pleasanton) |
| 4410 rosewood dr |
| pleasanton CA 94588 |
|
| Manufacturer (Section G) |
| Allergan (Pleasanton) |
| 4410 rosewood dr |
|
| pleasanton CA 94588 |
|
| Manufacturer Contact |
|
terry
ingram
|
| 2525 dupont drive |
| irvine, CA 92612
|
|
+1(847)936-6324
|
|
| MDR Report Key | 50828324 |
| Report Number | 3007215625-2026-00479 |
| Device Sequence Number | 12925090 |
| Product Code |
OOK
|
| UDI-Device Identifier | 00816417020001 |
| UDI-Public | (01)00816417020001 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | KU |
| PMA/510(K) Number | K160259 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,Distributor |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/18/2026 |
| 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
|
| Operator of Device |
Health Professional
|
| Device Catalogue Number | SA16787 |
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 09/02/2026 |
| Initial Report FDA Received Date | 09/18/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 10/20/2022 |
| 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 |
| Outcome Attributed to Adverse Event |
Required Intervention;
|
| Patient Age | 41 YR |
| Patient Sex | Female |
| Patient Weight | 129 LB |
|
|