FDA Adverse Event
Other
Summary report: N
A-DEC 6300 WALL MOUNT LIGHT
MDR report key: 175143
·
Received June 30, 1998
Report
- Report Number
- 3015729-1998-90001
- Event Type
- Other
- Date Received
- June 30, 1998
- Date of Event
- June 1, 1998
- Report Date
- June 24, 1998
- Manufacturer
- A-DEC, INC.
- Product Code
- EAZ
- Removal / Correction Number
- NA
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- IL, US
- Reporter Occupation
- DENTIST
Narratives
Description of Event or Problem · 1
A WALL MOUNT LIGHT FELL OFF THE WALL, ONTO THE DR'S SHOULDER AND PT SUFFERED FROM MULTIPLE CONTUSION, A LACERATION OVER THE TWO UPPER CENTRAL TEETH, TWO BROKEN LOWER CENTRAL TEETH AND TWO BLACK EYES.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | A-DEC 6300 WALL MOUNT LIGHT | DENTAL LIGHT | EAZ | A-DEC, INC. | 6300 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | * | Other |