MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2020-03-14 for NON LATEX ELASTIC HY (H4) 3/16 BERN 11-302-04 manufactured by Dentsply Sirona Orthodontics Inc..
| Report Number | 1036212-2020-00002 |
| MDR Report Key | 9833008 |
| Report Source | HEALTH PROFESSIONAL |
| Date Received | 2020-03-14 |
| Date of Report | 2020-03-13 |
| Date of Event | 2020-02-07 |
| Date Mfgr Received | 2020-02-12 |
| Date Added to Maude | 2020-03-14 |
| 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 | MR. KARL NITTINGER |
| Manufacturer Street | 221 W. PHILADELPHIA ST. SUITE 60W |
| Manufacturer City | YORK, PA |
| Manufacturer Country | US |
| Manufacturer Phone | 8494424 |
| Manufacturer G1 | DENTSPLY SIRONA ORTHODONTICS INC. |
| Manufacturer Street | 7290 26TH COURT EAST |
| Manufacturer City | SARASOTA, FL |
| Manufacturer Country | US |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | NON LATEX ELASTIC HY (H4) 3/16 BERN |
| Generic Name | BAND, ELASTIC, ORTHODONTIC |
| Product Code | ECI |
| Date Received | 2020-03-14 |
| Model Number | NA |
| Catalog Number | 11-302-04 |
| Lot Number | 00111424 |
| Device Expiration Date | 2020-03-12 |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DENTSPLY SIRONA ORTHODONTICS INC. |
| Manufacturer Address | 7290 26TH COURT EAST SARASOTA, FL US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2020-03-14 |