DUAL CHAMBER SYRINGE SEALER RIBBON

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-10-17 for DUAL CHAMBER SYRINGE SEALER RIBBON manufactured by Tulsa Dental Products Llc.

MAUDE Entry Details

Report Number2320721-2019-00211
MDR Report Key9204588
Date Received2019-10-17
Date of Report2019-10-11
Date Added to Maude2019-10-17
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationDENTIST
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMR. KARL NITTINGER
Manufacturer Street221 W. PHILADELPHIA ST. SUITE 60W
Manufacturer CityYORK PA 17401
Manufacturer CountryUS
Manufacturer Postal17401
Manufacturer Phone7178494424
Manufacturer G1DENTSPLY DETREY GMBH
Manufacturer StreetDETREY STRASSE 1
Manufacturer CityKONSTANZ, 78467
Manufacturer CountryGM
Manufacturer Postal Code78467
Single Use3
Previous Use Code3
Event Type3
Type of Report0

Device Details

Brand NameDUAL CHAMBER SYRINGE SEALER
Generic NameRESIN, ROOT CANAL FILLING
Product CodeKIF
Date Received2019-10-17
Model NumberNA
Catalog NumberRIBBON
Lot NumberUNK
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device Eval'ed by MfgrN
Device Sequence No1
Device Event Key0
ManufacturerTULSA DENTAL PRODUCTS LLC
Manufacturer Address608 ROLLING HILLS DRIVE JOHNSON CITY TN 37604 US 37604


Patients

Patient NumberTreatmentOutcomeDate
10 2019-10-17

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