Brand Name | PROVISC OPHTHALMIC VISCOSURGICAL DEVICE |
Type of Device | AID, SURGICAL, VISCOELASTIC |
Manufacturer (Section D) |
ALCON - COUVREUR N.V./ALCON - BELGIUM |
rijksweg 14 |
puurs B-287 0 |
BE B-2870 |
|
Manufacturer (Section G) |
ALCON - COUVREUR N.V./ALCON - BELGIUM |
rijksweg 14 |
|
puurs B-287 0 |
BE
B-2870
|
|
Manufacturer Contact |
cindy
milam
|
6201 south freeway |
mail stop ab2-6 |
fort worth, TX 76134
|
8176152231
|
|
MDR Report Key | 8492867 |
MDR Text Key | 141436114 |
Report Number | 3002037047-2019-00005 |
Device Sequence Number | 1 |
Product Code |
LZP
|
Combination Product (y/n) | N |
Reporter Country Code | JA |
PMA/PMN Number | P890047 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
foreign,health professional |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
04/08/2019 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 04/08/2019 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Catalogue Number | 960569J--001/0 |
Device Lot Number | ASKU |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Date Manufacturer Received | 03/26/2019 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
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 |