WALGREENS ORTHO WX 2PK ORTHO WX 2PK CD

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-09-09 for WALGREENS ORTHO WX 2PK ORTHO WX 2PK CD manufactured by Ranir Llc.

MAUDE Entry Details

Report Number1825660-2019-00612
MDR Report Key8976125
Date Received2019-09-09
Date of Report2019-09-09
Date of Event2019-08-15
Date Facility Aware2019-08-16
Date Mfgr Received2019-08-16
Date Added to Maude2019-09-09
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactREBEKAH STENSKE
Manufacturer Street4701 EAST PARIS AVE. SE
Manufacturer CityGRAND RAPIDS MI 495125353
Manufacturer CountryUS
Manufacturer Postal495125353
Manufacturer Phone6166988880
Manufacturer G1RANIR LLC
Manufacturer Street4701 EAST PARIS AVE. SE
Manufacturer CityGRAND RAPIDS MI 495125353
Manufacturer CountryUS
Manufacturer Postal Code495125353
Single Use3
Previous Use Code3
Event Type3
Type of Report0

Device Details

Brand NameWALGREENS ORTHO WX 2PK
Generic NameWAX, DENTAL, INTRAORAL
Product CodeEGD
Date Received2019-09-09
Model NumberORTHO WX 2PK CD
OperatorLAY USER/PATIENT
Device AvailabilityN
Device Eval'ed by Mfgr*
Device Sequence No1
Device Event Key0
ManufacturerRANIR LLC
Manufacturer Address4701 EAST PARIS AVE. SE GRAND RAPIDS MI 495125353 US 495125353


Patients

Patient NumberTreatmentOutcomeDate
10 2019-09-09

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