MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 06 report with the FDA on 2008-10-09 for 765DC INTRAORAL X-RAY 110-0155G1 A0765DC75 manufactured by Gendex Dental Systems.
[943732]
The spring in the arm of the unit broke, swinging out and hitting the dental assistant in the stomach.
Patient Sequence No: 1, Text Type: D, B5
[8099165]
There was no patient or user injury with this event. Results - the retaining ring on the spring of the articulated arm broke allowing the spring to release causing the arm to swing out. Conclusions - the articulated arm was replaced.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 3004115000-2008-00016 |
| MDR Report Key | 1197786 |
| Report Source | 06 |
| Date Received | 2008-10-09 |
| Date of Report | 2008-09-18 |
| Date of Event | 2008-09-17 |
| Date Mfgr Received | 2008-09-18 |
| Device Manufacturer Date | 2001-08-09 |
| Date Added to Maude | 2009-07-21 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Reporter Occupation | DENTIST |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | MARI LAMBERT, MANAGER |
| Manufacturer Street | 901 W. OAKTON |
| Manufacturer City | DES PLAINES IL 60018 |
| Manufacturer Country | US |
| Manufacturer Postal | 60018 |
| Manufacturer Phone | 8473643958 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | 765DC INTRAORAL X-RAY |
| Generic Name | DENTAL X-RAY EQUIPMENT |
| Product Code | EAP |
| Date Received | 2008-10-09 |
| Model Number | 110-0155G1 |
| Catalog Number | A0765DC75 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | GENDEX DENTAL SYSTEMS |
| Manufacturer Address | 901 W. OAKTON DES PLAINES IL 60018 US 60018 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2008-10-09 |