MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 08 report with the FDA on 2008-10-20 for BITE-GARD MOLAR BITE BLOCK 1140 manufactured by Teleflex Medical.
[980580]
The event was reported as: green plastic end became dislodged and had to be retrieved from the pt's oropharynx. No pt injury reported. No further info available.
Patient Sequence No: 1, Text Type: D, B5
[8214245]
Sample requested, but not received yet. Evaluation report not available at time of this report.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 3004365956-2008-00058 |
| MDR Report Key | 1204670 |
| Report Source | 08 |
| Date Received | 2008-10-20 |
| Date of Report | 2008-10-03 |
| Date Mfgr Received | 2008-10-03 |
| Date Added to Maude | 2009-06-11 |
| 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 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | ANGELA BROWN, MGR, RA |
| Manufacturer Street | 4024 STIRRUP CREEK DR |
| Manufacturer City | DURHAM NC 27703 |
| Manufacturer Country | US |
| Manufacturer Postal | 27703 |
| Manufacturer Phone | 9194334901 |
| Manufacturer G1 | TELEFLEX MEDICAL |
| Manufacturer Street | AVE. INDUSTRIAS NO.5954 PARQUE INDUSTRIAL FINSA |
| Manufacturer City | NUEVO LAREDO, TAMAULIPAS 88275 |
| Manufacturer Country | MX |
| Manufacturer Postal Code | 88275 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | BITE-GARD MOLAR BITE BLOCK |
| Generic Name | BITE GARD |
| Product Code | JXL |
| Date Received | 2008-10-20 |
| Catalog Number | 1140 |
| Lot Number | 2602617309 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | TELEFLEX MEDICAL |
| Manufacturer Address | NUEVO LAREDO, TAMAULIPAS MX |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2008-10-20 |