BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    IVORY RUBBER DAM CLAMP

    MDR report key: 37789 · Received September 12, 1996

    Report

    Report Number
    MW1009919
    Event Type
    Malfunction
    Date Received
    September 12, 1996
    Manufacturer
    DENTAL PRODUCTS DIV. MILES, INC.
    Product Code
    EEF
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MN, US
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    RUBBER DAM CLAMP WAS PLACED AND BROKE IN THE PT'S MOUTH. IT COULD HAVE BEEN SWALLOWED CAUSING ASPIRATION OF THE CLAMP, BUT LUCKILY IT WAS NOT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IVORY RUBBER DAM CLAMP RUBBER DAM CLAMP EEF DENTAL PRODUCTS DIV. MILES, INC. * *

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other