Brand Name | NSK |
Type of Device | DENTAL HANDPIECE |
Manufacturer (Section D) |
NAKANISHI INC. |
700 shimohinata |
kanuma, tochigi 322-8 666 |
JA 322-8666 |
|
MDR Report Key | 15402702 |
MDR Text Key | 299697253 |
Report Number | 1422375-2022-00034 |
Device Sequence Number | 1 |
Product Code |
KMW
|
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Distributor
|
Reporter Occupation |
Administrator/Supervisor
|
Type of Report
| Initial |
Report Date |
08/31/2022,08/11/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Model Number | SGS-E2S |
Device Catalogue Number | H266 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 09/08/2022 |
Was the Report Sent to FDA? |
No
|
Distributor Facility Aware Date | 08/11/2022 |
Device Age | 4 YR |
Event Location |
Hospital
|
Date Report to Manufacturer | 08/31/2022 |
Initial Date Manufacturer Received |
Not provided
|
Initial Date FDA Received | 09/12/2022 |
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Other;
|
Patient Age | 65 YR |
Patient Sex | Male |
Patient Ethnicity | Non Hispanic |
|
|