MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-07-17 for INCLUSIVE DRILL EXTENDER 70-1071-SRG0014 manufactured by Prismatik Dentalcraft, Inc..
| Report Number | 3011649314-2019-00331 |
| MDR Report Key | 8798615 |
| Date Received | 2019-07-17 |
| Date of Report | 2019-07-17 |
| Date of Event | 2019-06-21 |
| Date Mfgr Received | 2019-06-21 |
| Device Manufacturer Date | 2019-04-05 |
| Date Added to Maude | 2019-07-17 |
| 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 | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. HERBERT SCHOENHOEFER |
| Manufacturer Street | 2212 DUPONT DRIVE SUITE P |
| Manufacturer City | IRVINE CA 92612 |
| Manufacturer Country | US |
| Manufacturer Postal | 92612 |
| Manufacturer Phone | 9494402632 |
| Manufacturer G1 | PRISMATIK DENTALCRAFT, INC. |
| Manufacturer Street | 2212 DUPONT DR SUITE P |
| Manufacturer City | IRVINE CA 92612 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 92612 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | INCLUSIVE DRILL EXTENDER |
| Generic Name | INCLUSIVE DRILL EXTENDER |
| Product Code | DZA |
| Date Received | 2019-07-17 |
| Model Number | 70-1071-SRG0014 |
| Catalog Number | 70-1071-SRG0014 |
| Lot Number | 6069352 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | PRISMATIK DENTALCRAFT, INC. |
| Manufacturer Address | 2212 DUPONT DRIVE SUITE P IRVINE CA 92612 US 92612 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-07-17 |