MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-11-15 for COM-FIT SUPER SENSITIVE EAR LOOP WHITE 0020346FG manufactured by Dentsply Llc.
| Report Number | 2424472-2019-00187 |
| MDR Report Key | 9330971 |
| Date Received | 2019-11-15 |
| Date of Report | 2019-11-15 |
| Date Mfgr Received | 2019-10-16 |
| Date Added to Maude | 2019-11-15 |
| 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 |
| Reporter Occupation | DENTIST |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. KARL NITTINGER |
| Manufacturer Street | 221 W. PHILADELPHIA ST. SUITE 60W |
| Manufacturer City | YORK PA 17401 |
| Manufacturer Country | US |
| Manufacturer Postal | 17401 |
| Manufacturer Phone | 7178494424 |
| Manufacturer G1 | PRESTIGE AMERITECH |
| Manufacturer Street | 7201 IRON HORSE BLVD. |
| Manufacturer City | NORTH RICHLAND HILLS TX 76180 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 76180 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | COM-FIT SUPER SENSITIVE EAR LOOP WHITE |
| Generic Name | MASK, SURGICAL |
| Product Code | FXX |
| Date Received | 2019-11-15 |
| Returned To Mfg | 2019-11-07 |
| Model Number | NA |
| Catalog Number | 0020346FG |
| Lot Number | 19191646 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DENTSPLY LLC |
| Manufacturer Address | 1301 SMILE WAY YORK PA 17404 US 17404 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2019-11-15 |