BEUDAMED
    FDA Adverse Event Summary report: N

    AQUA FRESH-AQUA BLAST

    MDR report key: 512470 · Received December 16, 2003

    Report

    Report Number
    MW4003660
    Date Received
    December 16, 2003
    Report Date
    December 16, 2003
    Manufacturer
    GLAXO SMITH KLINE
    Product Code
    MDZ
    Report Source
    Voluntary report
    Reporter Occupation
    PATIENT

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AQUA FRESH-AQUA BLAST TOOTH BRUSH CLEANER 16 TABLETS BLISTER PACK MDZ GLAXO SMITH KLINE * MG153

    Patients

    Seq Age Sex Outcome Treatment
    1 *