Brand Name | LIGHTFORCE |
Type of Device | THERAPY LASER |
Manufacturer (Section D) |
LITECURE, LLC |
101 lukens drive |
suite a |
new castle DE 19720 2791 |
|
Manufacturer (Section G) |
LITECURE, LLC |
101 lukens drive |
suite a |
new castle DE 19720 2791 |
|
Manufacturer Contact |
eric
rock
|
101 lukens drive |
suite a |
new castle, DE 19720-2791
|
3027090408
|
|
MDR Report Key | 8437489 |
MDR Text Key | 139373520 |
Report Number | 3006268867-2019-00002 |
Device Sequence Number | 1 |
Product Code |
ILY
|
UDI-Device Identifier | 00854103007042 |
UDI-Public | (01)00854103007042(11)180328 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | EXEMPT |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
health professional |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial |
Report Date |
03/04/2019 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 03/20/2019 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Model Number | LTC-1500 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 03/28/2018 |
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Reuse
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 45 YR |