MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-10-22 for PERMANENT UNIVERSAL TOOTH FILLING COMPOSITE RESIN SELF CURE 273935071593 EBAY manufactured by Prime Dental Manufacturing, Inc..
| Report Number | MW5090559 |
| MDR Report Key | 9224803 |
| Date Received | 2019-10-22 |
| Date of Report | 2019-10-21 |
| Date of Event | 2019-10-17 |
| Date Added to Maude | 2019-10-23 |
| 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 | PATIENT |
| 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 | PERMANENT UNIVERSAL TOOTH FILLING COMPOSITE RESIN SELF CURE |
| Generic Name | MATERIAL, TOOTH SHADE, RESIN |
| Product Code | EBF |
| Date Received | 2019-10-22 |
| Model Number | 273935071593 EBAY |
| Device Expiration Date | 2019-10-06 |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Eval'ed by Mfgr | I |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | PRIME DENTAL MANUFACTURING, INC. |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-10-22 |