BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DISPERS ALLOY AMALGAM DENTAL FILLING

    MDR report key: 29232 · Received January 3, 1996

    Report

    Report Number
    MW1008048
    Event Type
    Injury
    Date Received
    January 3, 1996
    Date of Event
    November 23, 1995
    Report Date
    December 18, 1995
    Manufacturer
    THE LD. CAULK CO.
    Product Code
    EJJ
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TX, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    PT HAD AMALGAM DENTAL FILLING NINE TIMES IN 9/95. PT HAD FIRST SEIZURE 10/26/95 AND 2ND SEIZURE ON 11/23/95. MRI OF BRAIN, EEG AND THE OTHER SEIZURE WORK-UP WERE NEGATIVE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DISPERS ALLOY AMALGAM DENTAL FILLING AMALGAM DENTAL FILLING EJJ THE LD. CAULK CO.

    Patients

    Seq Age Sex Outcome Treatment
    1 21 YR Hospitalization