Brand Name | GUM PROXABRUSH |
Type of Device | INTERDENTAL BRUSH |
Manufacturer (Section D) |
SUNSTAR INC |
301 e. central rd |
schaumburg IL 60195 |
|
Manufacturer (Section G) |
|
Manufacturer Contact |
paula
wendland
|
schaumburg, IL 60195
|
7733554024
|
|
MDR Report Key | 19106765 |
MDR Text Key | 340811772 |
Report Number | 1413787-2024-00104 |
Device Sequence Number | 1 |
Product Code |
EFW
|
Combination Product (y/n) | N |
Reporter Country Code | AR |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
04/15/2024 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 04/15/2024 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Model Number | 1414AR |
Was Device Available for Evaluation? |
No
|
Distributor Facility Aware Date | 03/21/2024 |
Date Manufacturer Received | 03/21/2024 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Type of Device Usage |
A
|
Patient Sequence Number | 1 |
|
|