BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CAVITRON JET-FRESH, MINT

    MDR report key: 476106 · Received August 7, 2003

    Report

    Report Number
    2424472-2003-00097
    Event Type
    Injury
    Date Received
    August 7, 2003
    Report Date
    July 9, 2003
    Manufacturer
    DENTSPLY PROFESSIONAL
    Product Code
    EJR
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AL, US
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    THE DOCTOR REPORTED THAT FOUR STAFF MEMBERS AND ONE PT HAD AN ALLERGIC REACTION TO JET FRESH. ONE STAFF MEMBER REQUIRED A SHOT OF BENEDRYL FOR TREATMENT OF HIVES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CAVITRON JET-FRESH, MINT CLEANING POWDER EJR DENTSPLY PROFESSIONAL NA 030117

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Required Intervention