BEUDAMED
    FDA Adverse Event Other Summary report: N

    MILTEX

    MDR report key: 101214 · Received June 25, 1997

    Report

    Report Number
    2431021-1997-00003
    Event Type
    Other
    Date Received
    June 25, 1997
    Date of Event
    June 2, 1997
    Report Date
    June 23, 1997
    Manufacturer
    MILTEX INSTRUMENT CO. INC
    Product Code
    EAX
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    ON 6/02/97 DURING DENTAL TREATMENT THE MIRROR HEAD DISCONNECTED AT THE SOLDER (SPOTWELD) JOINT AND WAS SWALLOWED BY THE PT. FOLLOW UP NOT KNOWN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MILTEX DENTAL MIRROR EAX MILTEX INSTRUMENT CO. INC UNK UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 47 YR Required Intervention