BEUDAMED
    FDA Adverse Event Injury Summary report: N

    *

    MDR report key: 178661 · Received July 21, 1998

    Report

    Report Number
    MW1014221
    Event Type
    Injury
    Date Received
    July 21, 1998
    Date of Event
    February 20, 1992
    Report Date
    July 14, 1998
    Manufacturer
    UNK
    Product Code
    DZS
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    ONSET OVER SEVERAL YRS OF ALLERGY, ASTHMA, CHRONIC FATIGUE, DEPRESSION, EMOTIONAL DISTURBANCES, ATAXIA, SHORT TERM MEMORY LOSS, FOOD SENSITIVITIES, HYPOTHYROIDISM, HYPOGONADISM, DIABETES INSIPIDUS. THIS FOLLOWED INSTALLATION OF 2 AMALGAM FILLINGS NEAR GUM LINE IN UPPER WISDOM TEETH.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * Implant DENTAL AMALGAM DZS UNK * *

    Patients

    Seq Age Sex Outcome Treatment
    1 35 YR Required Intervention| S LEVOXYL & CYTOMEL FROM 1994.