Brand Name | PALAXPRESS LIQUID |
Type of Device | RESIN, DENTURE, RELINING, REPAIRING, REBASING |
Manufacturer (Section D) |
HERAEUS KULZER GMBH |
philipp-reis-strasse 8/13 |
wehrheim, D-612 73 |
GM D-61273 |
|
Manufacturer (Section G) |
HERAEUS KULZER GMBH |
philipp-reis-strasse 8/13 |
|
wehrheim, D-612 73 |
GM
D-61273
|
|
Manufacturer Contact |
rita
rogers
|
300 heraeus way |
south bend, IN 46614
|
5742995409
|
|
MDR Report Key | 5471490 |
MDR Text Key | 39415992 |
Report Number | 9610902-2016-00006 |
Device Sequence Number | 1 |
Product Code |
EBI
|
Combination Product (y/n) | N |
Reporter Country Code | GM |
PMA/PMN Number | K902115 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
consumer |
Reporter Occupation |
Patient
|
Type of Report
| Initial |
Report Date |
02/11/2016 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 03/01/2016 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Dentist
|
Device Catalogue Number | 64711631 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
No
|
Distributor Facility Aware Date | 02/11/2016 |
Date Manufacturer Received | 02/11/2016 |
Was Device Evaluated by Manufacturer? |
No
|
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Other;
|
Patient Age | 65 YR |
|
|