BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MOUTH MIRROR DENTAL REFLECTOR

    MDR report key: 2535604 · Received April 6, 2012

    Report

    Report Number
    2535604
    Event Type
    Malfunction
    Date Received
    April 6, 2012
    Date of Event
    March 9, 2012
    Report Date
    April 6, 2012
    Manufacturer
    STORZ
    Product Code
    EAX
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    WI, US
    Reporter Occupation
    RISK MANAGER

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MOUTH MIRROR DENTAL REFLECTOR DENTAL MIRROR EAX STORZ * *

    Patients

    Seq Age Sex Outcome Treatment
    1 4 YR