BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    DISTAL END CUTTER

    MDR report key: 1735452 · Received June 16, 2010

    Report

    Report Number
    2086211-2010-00090
    Event Type
    Malfunction
    Date Received
    June 16, 2010
    Report Date
    May 19, 2010
    Manufacturer
    GAC INTL
    Product Code
    EJB
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    LA, US
    Reporter Occupation
    DENTIST

    Narratives

    Additional Manufacturer Narrative · 1

    WHILE NO SERIOUS INJURY RESULTED IN THIS EVENT, THERE HAS BEEN A PREVIOUS REPORT RECEIVED IN THE PAST TWO YRS INVOLVING THE SAME DEVICE WHERE THIS MALFUNCTION RESULTED IN A SERIOUS INJURY. THEREFORE, THIS EVENT MEETS THE CRITERIA FOR REPORTABILITY PER 21 CFR PART 803. THE DEVICE IS AVAILABLE FOR EVALUATION, THOUGH HAS NOT BEEN RETURNED AS OF THIS REPORT.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE TIP OF A DISTAL END CUTTER SEPARATED WHILE CUTTING WIRE IN A PT'S MOUTH; NO INJURY RESULTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DISTAL END CUTTER EJB GAC INTL 09-28-4

    Patients

    Seq Age Sex Outcome Treatment
    1 16X22SS WIRE