MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 08 report with the FDA on 2009-12-08 for PROGENY PREVA P7017 manufactured by Midmark Corp..
[1443377]
A service tech from the distributor reported that the mechanical structure of a preva intraoral unit, (b) (4), separated from its wall mount at dr. (b) (6) dental office. No injury was reported.
Patient Sequence No: 1, Text Type: D, B5
[8507447]
Results: wrong lag screw: the top lag screw, which broke, is 1/4 inch diameter, while progeny provides two 3/8 inch lag screws for the purpose of wall attachment, and calls for the use of 3/8 inch lag screw in the installation manual. Insufficient backing: the supporting wall is made of particle board and plywood. Both of these materials are specifically identified in the installation manual as being inadequate for support purposes. Conclusion: improper installation.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1423380-2009-00025 |
| MDR Report Key | 1575307 |
| Report Source | 08 |
| Date Received | 2009-12-08 |
| Date of Report | 2009-12-08 |
| Date of Event | 2009-11-11 |
| Date Mfgr Received | 2009-11-11 |
| Device Manufacturer Date | 2008-02-01 |
| Date Added to Maude | 2010-07-12 |
| 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 | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | LISA BARTAKOVICS |
| Manufacturer Street | 675 HEATHROW DR. |
| Manufacturer City | LINCOLNSHIRE IL 60069 |
| Manufacturer Country | US |
| Manufacturer Postal | 60069 |
| Manufacturer Phone | 8474159800 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | PROGENY PREVA |
| Product Code | MUH |
| Date Received | 2009-12-08 |
| Model Number | PREVA |
| Catalog Number | P7017 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | MIDMARK CORP. |
| Manufacturer Address | 675 HEATHROW DR. LINCOLNSHIRE IL 60069 US 60069 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2009-12-08 |