BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PROULTRA ENDO TIPS

    MDR report key: 720874 · Received May 26, 2006

    Report

    Report Number
    2029155-2006-00190
    Event Type
    Malfunction
    Date Received
    May 26, 2006
    Date of Event
    April 27, 2006
    Report Date
    April 27, 2006
    Manufacturer
    DENTSPLY TULSA
    Product Code
    ELC
    PMA / PMN Number
    K960889
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    A PROFILE ENDO TIP SEPERATED THE SEPERATED PIECE WAS RETRIEVED WITHOUT SEQUELA.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PROULTRA ENDO TIPS ELC ELC DENTSPLY TULSA NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN