INCIDENT REPORTING INCIDENT REPORTING Please describe the incident, listing xactTM IOL Model and serial number, Surgeon’s name and the name and address of the hospital/clinic where the incident occurred; the date of the incident; patient condition; indicate whether secondary surgical intervention was needed and whether the IOL was explanted. Description of Incident: Patient Condition (required): Was secondary surgical intervention needed? YesNo Date of the incident: Identification of the IOL involved Model: Serial #: Surgeon's Name: Address of the hospital/clinic: Reporter contact information: Name: Email: