BEUDAMED
    FDA Adverse Event Other Summary report: N

    ELLMAN ELECTRODE

    MDR report key: 271708 · Received March 31, 2000

    Report

    Report Number
    2428235-2000-00001
    Event Type
    Other
    Date Received
    March 31, 2000
    Date of Event
    March 1, 1997
    Report Date
    March 31, 1997
    Manufacturer
    ELLMAN INTERNATIONAL INC
    Product Code
    JOS
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, US
    Reporter Occupation
    ATTORNEY

    Narratives

    Description of Event or Problem · 1

    PT RECEIVED BURN TO RIGHT SIDE OF MOUTH WHEN DENTIST PLACED DEVICE IN PT'S MOUTH.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ELLMAN ELECTRODE STANDARD ELECTRODE JOS ELLMAN INTERNATIONAL INC #111 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other