MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2005-01-05 for HOLLENBACK * manufactured by Unk.
[374814]
Hollenback dental instrument broke when in use. All parts retrieved, no injury to patient. Dental case, throat pack in place
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 566173 |
| MDR Report Key | 566173 |
| Date Received | 2005-01-05 |
| Date of Report | 2005-01-05 |
| Date of Event | 2004-11-04 |
| Report Date | 2005-01-05 |
| Date Reported to FDA | 2005-01-05 |
| Date Added to Maude | 2005-01-20 |
| Event Key | 0 |
| Report Source Code | User Facility report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 0 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 0 |
| Previous Use Code | 0 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | HOLLENBACK |
| Generic Name | DENTAL INSTRUMENT |
| Product Code | EJB |
| Date Received | 2005-01-05 |
| Model Number | * |
| Catalog Number | * |
| Lot Number | * |
| ID Number | * |
| Operator | UNKNOWN |
| Device Availability | N |
| Implant Flag | N |
| Date Removed | * |
| Device Sequence No | 1 |
| Device Event Key | 555959 |
| Manufacturer | UNK |
| Manufacturer Address | * * * |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2005-01-05 |