BEUDAMED
    FDA Adverse Event Summary report: N

    BLUEPHASE LIGHT PROBE 10MM BLACK (STYLE

    MDR report key: 4368645 · Received September 16, 2014

    Report

    Report Number
    9612352-2014-00016
    Date Received
    September 16, 2014
    Date of Event
    August 7, 2014
    Report Date
    September 15, 2014
    Manufacturer
    IVOCLAR VIVADENT, AG
    Product Code
    EBZ
    PMA / PMN Number
    K110756
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    PROBE BROKE IN PT'S MOUTH.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    574052 BLUEPHASE LIGHT PROBE 10MM BLACK (STYLE ACTIVATORY, POLYMERIZATION EBZ IVOCLAR VIVADENT, AG

    Patients

    Seq Age Sex Outcome Treatment
    1