MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-08-19 for TEMPLATE ULTRA QUICK MATRIX MATERIAL manufactured by Clinician's Choice Dental Products, Inc.
| Report Number | MW5089202 |
| MDR Report Key | 8912698 |
| Date Received | 2019-08-19 |
| Date of Report | 2019-08-07 |
| Date of Event | 2019-07-25 |
| Date Added to Maude | 2019-08-20 |
| Event Key | 0 |
| Report Source Code | Voluntary report |
| Manufacturer Link | N |
| 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 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | TEMPLATE ULTRA QUICK MATRIX MATERIAL |
| Generic Name | MATERIAL, IMPRESSION |
| Product Code | ELW |
| Date Received | 2019-08-19 |
| Lot Number | 733732D |
| Device Availability | Y |
| Device Eval'ed by Mfgr | I |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | CLINICIAN'S CHOICE DENTAL PRODUCTS, INC |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2019-08-19 |