BEUDAMED
    FDA Adverse Event Injury Summary report: N

    FIBER POST REMOVAL KIT

    MDR report key: 276130 · Received May 1, 2000

    Report

    Report Number
    1420052-2000-00001
    Event Type
    Injury
    Date Received
    May 1, 2000
    Date of Event
    March 30, 2000
    Report Date
    May 1, 2000
    Manufacturer
    RTD
    Product Code
    EJY
    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

    PILOT DRILL BROKE OFF IN CANAL AS DENTIST WAS INSERTING IT. DRILL BROKE OFF INSIDE OF THE TOOTH AND PT REQUESTED TO HAVE TOOTH EXTRACTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 FIBER POST REMOVAL KIT DRILL EJY RTD NA SEE H10

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR Required Intervention