BEUDAMED
    FDA Adverse Event Other Summary report: N

    EXPLORER SE #23

    MDR report key: 496466 · Received November 18, 2003

    Report

    Report Number
    2411236-2003-10504
    Event Type
    Other
    Date Received
    November 18, 2003
    Date of Event
    November 13, 2003
    Report Date
    November 17, 2003
    Manufacturer
    SHANGHAI DENTAL INSTRUMENT FACTORY
    Product Code
    EKB
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    NY, US
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    TIP OF EXPLORER BROKE OFF DURING A DENTAL PROCEDURE. PT SWALLOWED TIP-WENT TO E.R. FOR X-RAYS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EXPLORER SE #23 DENTAL INSTRUMENT EKB SHANGHAI DENTAL INSTRUMENT FACTORY * 0103

    Patients

    Seq Age Sex Outcome Treatment
    1 33 YR Other