BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ORTHO SOURCE

    MDR report key: 1031629 · Received April 7, 2008

    Report

    Report Number
    MW5006316
    Event Type
    Malfunction
    Date Received
    April 7, 2008
    Date of Event
    April 4, 2008
    Report Date
    April 7, 2008
    Manufacturer
    ORTHO SOURCE
    Product Code
    DZC
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    DENTIST

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ORTHO SOURCE GOLD MESH DISK DZC ORTHO SOURCE

    Patients

    Seq Age Sex Outcome Treatment
    1 40 YR Other