BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNK

    MDR report key: 1685974 · Received May 7, 2010

    Report

    Report Number
    MW5015882
    Event Type
    Injury
    Date Received
    May 7, 2010
    Date of Event
    March 15, 2009
    Report Date
    May 7, 2010
    Manufacturer
    UNK
    Product Code
    EJJ
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    MERCURY AMALGAM LED TO ORAL CANCER, RESULTING IN A PARTIAL GLOSSECTOMY IN (B) (6) 2009, AND TOTAL GLOSSECTOMY BY (B) (6) 2009. DOSE OR AMOUNT: UNK, FREQUENCY: ONGOING EXPOSURE, ROUTE: DENTAL. DIAGNOSIS OR REASON FOR USE: FRACTURED TOOTH. EVENT ABATED AFTER USE: YES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNK MERCURY AMALGAM EJJ UNK UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 61 YR Hospitalization| L| R