MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2019-11-07 for PATTERSON SALIVA EJECTORS 107-3980 manufactured by Patterson Dental Supply, Inc..
| Report Number | 9611959-2019-00001 |
| MDR Report Key | 9293336 |
| Report Source | HEALTH PROFESSIONAL |
| Date Received | 2019-11-07 |
| Date of Report | 2019-10-11 |
| Date of Event | 2019-09-11 |
| Date Mfgr Received | 2019-09-11 |
| Date Added to Maude | 2019-11-07 |
| 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 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MS MAY KANSOU |
| Manufacturer Country | CA |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | PATTERSON SALIVA EJECTORS |
| Generic Name | SALIVA EJECTOR |
| Product Code | DYN |
| Date Received | 2019-11-07 |
| Catalog Number | 107-3980 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | 1 YR |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | PATTERSON DENTAL SUPPLY, INC. |
| Manufacturer Address | 1031 MENDOTA HEIGHTS RD. ST. PAUL MN 651953357 US 651953357 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-11-07 |