FDA Adverse Event
Malfunction
Summary report: N
IVORY RUBBER DAM CLAMP W3
MDR report key: 83933
·
Received April 10, 1997
Report
- Report Number
- 1925223-1997-00175
- Event Type
- Malfunction
- Date Received
- April 10, 1997
- Report Date
- March 25, 1997
- Manufacturer
- HERAEUS KULZER, INC. DENTAL PRODUCTS DIV.
- Product Code
- EEF
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- GA, US
- Reporter Occupation
- DENTIST
Narratives
Description of Event or Problem · 1
NEW CLAMP BROKE IN MOUTH.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | IVORY RUBBER DAM CLAMP W3 | RUBBER DAM CLAMP | EEF | HERAEUS KULZER, INC. DENTAL PRODUCTS DIV. | * | * |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | UNKNOWN |