FDA Adverse Event
Malfunction
Summary report: N
IVORY RUBBER DAM CLAMP W3
MDR report key: 83916
·
Received April 10, 1997
Report
- Report Number
- 1925223-1997-00168
- Event Type
- Malfunction
- Date Received
- April 10, 1997
- Manufacturer
- HERAEUS KULZER, INC.
- Product Code
- EEF
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- VA, US
- Reporter Occupation
- DENTIST
Narratives
Description of Event or Problem · 1
CLAMP BROKE ON FIRST USE.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | IVORY RUBBER DAM CLAMP W3 | RUBBER DAM CLAMP | EEF | HERAEUS KULZER, INC. | * | UNK |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | UNKNOWN |