CHAIRMAN DENTAL CHAIR L1 007890

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 1997-03-05 for CHAIRMAN DENTAL CHAIR L1 007890 manufactured by Siemens Pelton & Crane.

Event Text Entries

[16031768] The doctor was reclining a pt in a dental chair when the chair back cracked. The chair back did not break off and fall but just jolted the pt a little when it cracked. This event did not occur during a dental procedure but during the reclining of the pt to an operating position. There were no injuries reported.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1017522-1997-00068
MDR Report Key74456
Report Source05
Date Received1997-03-05
Date of Report1997-03-05
Date of Event1997-02-06
Device Manufacturer Date1984-02-01
Date Added to Maude1997-03-11
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag0
Reporter OccupationDENTIST
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Single Use3
Remedial ActionRP
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameCHAIRMAN DENTAL CHAIR
Generic NameDENTAL OPERATORY CHAIR
Product CodeKLC
Date Received1997-03-05
Model NumberL1
Catalog Number007890
Lot NumberN/A
ID Number*
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Age*
Device Eval'ed by MfgrR
Implant FlagN
Date RemovedA
Device Sequence No1
Device Event Key74265
ManufacturerSIEMENS PELTON & CRANE
Manufacturer Address11727 FRUEHAUF DRIVE CHARLOTTE NC 282417800 US
Baseline Brand NameCHAIRMAN
Baseline Generic NameDENTAL CHAIR
Baseline Model NoL1
Baseline Catalog No007890
Baseline IDNA
Baseline Device FamilyDENTAL OPERATORY WITH ACCESSORIES
Baseline Shelf Life ContainedA
Baseline Shelf Life [Months]*
Baseline PMA FlagN
Baseline 510K PMNN
Baseline PreamendmentN
Baseline TransitionalN
510k ExemptN


Patients

Patient NumberTreatmentOutcomeDate
10 1997-03-05

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