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.

Was secondary surgical intervention needed?(Required)
MM slash DD slash YYYY

Identification of the IOL involved

Reporter contact information: