BEUDAMED
    FDA Adverse Event Other Summary report: N

    ROOF TIP ELEVATOR #80

    MDR report key: 583209 · Received March 21, 2005

    Report

    Report Number
    2411236-2005-13542
    Event Type
    Other
    Date Received
    March 21, 2005
    Date of Event
    February 18, 2005
    Report Date
    March 21, 2005
    Manufacturer
    J & J INSTRUMENTS INC
    Product Code
    EMJ
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    CA
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    WHILE REMOVING FOUR WISDOM TEETH, THE ELEVATOR TIP FRACTURED AND BECAME LODGED IN THE SURGERY SITE. THE FRACTURE WENT UNNOTICED UNTIL THE WORK SPACE WAS CLEANED. PATIENT HAD AN X-RAY TAKEN WHERE THE FRACTURED TIP WAS LOCATED. PATIENT WAS ALLOWED ONE WEEK TO HEAL FROM ORIGINAL SURGERY ADN THEN, USING SUCTION, DOCTOR REMOVED THE TIP. PATIENT IS DOING WELL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ROOF TIP ELEVATOR #80 DENTAL INSTRUMENT EMJ J & J INSTRUMENTS INC * 0604A

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other