MAUDE MDR 2593894

MDR report key
2593894
Report number
1056191-2012-00001
Event key
0
Event type
3
Date of event
2012-04-26
Date received
2012-05-24
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
100
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
JODI HUTCHINS
Address
17401 COMMERCE PARK BLVD TAMPA FL 33647 US
Phone
813-813-8139
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1QUICK-FIT MOLAR BAND ASSEMBLIESECM - ORTHODONTIC BAND/TUBEORTHO TECHNOLOGY, INCECMQUICK-FITSPECIFIC UNKNOWNUNKNOWNR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12012-05-2401. R
22012-05-240

Event Narratives#

D

Patient 2

A DOCTOR'S OFFICE REPORTED THEY HAVE HAD AN ISSUE WITH WELDS FAILING IN ORTHODONTIC STAINLESS STEEL BANDS AND THIS ULTIMATELY CAUSED AN ISSUE REQUIRING MEDICAL INTERVENTION IN 2 PATIENTS. THE FIRST PATIENT, A (B)(6) FEMALE, WAS WEARING A FORCES APPLIANCE, THAT WAS PLACED IN THE MOUTH UTILIZING OUR ORTHODONTIC QUICK-FIT MOLAR BAND ASSEMBLIES. THE BUCCAL TUBE BROKE AWAY FROM THE BAND. THIS OCCURRED IN THE MIDDLE OF THE NIGHT AND BY THE TIME THE PATIENT REACHED THE ORTHODONTIST'S OFFICE THE BUCCAL MUCOSA WAS CUT AND COMPLETELY IRRITATED. SHE HAD SWELLING ON HER CHEEK. THE DOCTOR ADMINISTERED A MIXTURE OF BENZOCAINE AND ANTIBIOTICS TO FACILITATE HEALING AND PRESCRIBED ORAL ANTIBIOTICS AS WELL. A SECOND PATIENT, A (B)(6) MALE UTILIZING THE SAME TYPE OF FORCES APPLIANCE HAD A VERY SIMILAR PROBLEM AND THE DOCTOR TREATED THE EXACT SAME.

D

Patient 1

A DOCTOR'S OFFICE REPORTED THEY HAVE HAD AN ISSUE WITH WELDS FAILING IN ORTHODONTIC STAINLESS STEEL BANDS AND THIS ULTIMATELY CAUSED AN ISSUE REQUIRING MEDICAL INTERVENTION IN 2 PATIENTS. THE FIRST PATIENT, A (B)(6) FEMALE, WAS WEARING A FORCES APPLIANCE, THAT WAS PLACED IN THE MOUTH UTILIZING OUR ORTHODONTIC QUICK-FIT MOLAR BAND ASSEMBLIES. THE BUCCAL TUBE BROKE AWAY FROM THE BAND. THIS OCCURRED IN THE MIDDLE OF THE NIGHT AND BY THE TIME THE PATIENT REACHED THE ORTHODONTIST'S OFFICE THE BUCCAL MUCOSA WAS CUT AND COMPLETELY IRRITATED. SHE HAD SWELLING ON HER CHEEK. THE DOCTOR ADMINISTERED A MIXTURE OF BENZOCAINE AND ANTIBIOTICS TO FACILITATE HEALING AND PRESCRIBED ORAL ANTIBIOTICS AS WELL. A SECOND PATIENT, A (B)(6) MALE UTILIZING THE SAME TYPE OF FORCES APPLIANCE HAD A VERY SIMILAR PROBLEM AND THE DOCTOR TREATED THE EXACT SAME.

N

Patient 2

WE ARE THE LEGAL MANUFACTURER OF THE QUICK-FIT BAND ASSEMBLIES AND OBTAIN THEM FROM A MANUFACTURER IN BRAZIL. THE BANDS THAT FAILED WERE NOT RETURNED FOR EVALUATION, HOWEVER, THE CUSTOMER SENT BACK THE REMAINING BANDS FROM THEIR STOCK AND WE TESTED THEM AT OUR FACILITY. WE ALSO SENT A SAMPLING OF THE RETURNED BANDS TO THE MANUFACTURER FOR TESTING AS WELL. THE MANUFACTURER CONCLUDED THERE IS AN ISSUE IN THEIR MANUFACTURING PROCESS AND QC PROCESSES THAT DID NOT DETECT THE ISSUE IN OUR CUSTOMER'S RETURNED PRODUCT. ALL OF OUR INVENTORY WAS QUARANTINED AS SOON AS THIS INFORMATION WAS DETERMINED AND IT HAS ALL BEEN SENT BACK TO THE MANUFACTURER'S COUNTERPART IN THE US FOR EVALUATION, REPAIR OR REPLACEMENT. AT THIS TIME THEY ARE ENSURING THEIR PROPOSED CORRECTIVE ACTION IS EFFECTIVE BEFORE RETURNING ANY PRODUCT TO US. IN THE MEANTIME, WE ARE BACKORDERING QUICK-FIT ORDERS AND/OR SUGGESTING A SUBSTITUTE.

N

Patient 1

WE ARE THE LEGAL MANUFACTURER OF THE QUICK-FIT BAND ASSEMBLIES AND OBTAIN THEM FROM A MANUFACTURER IN (B)(4). THE BANDS THAT FAILED WERE NOT RETURNED FOR EVALUATION, HOWEVER THE CUSTOMER SENT BACK THE REMAINING BANDS FROM THEIR STOCK AND WE TESTED THEM AT OUR FACILITY. WE ALSO SENT A SAMPLING OF THE RETURNED BANDS TO THE MANUFACTURER FOR TESTING AS WELL. THE MANUFACTURER CONCLUDED THERE IS AN ISSUE IN THEIR MANUFACTURING PROCESS AND QC PROCESSES THAT DID NOT DETECT THE ISSUE IN OUR CUSTOMER'S RETURNED PRODUCT. ALL OF OUR INVENTORY WAS QUARANTINED AS SOON AS THIS INFORMATION WAS DETERMINED AND IT HAS ALL BEEN SENT BACK TO THE MANUFACTURER'S COUNTERPART IN THE US FOR EVALUATION, REPAIR OR REPLACEMENT. AT THIS TIME THEY ARE ENSURING THEIR PROPOSED CORRECTIVE ACTION IS EFFECTIVE BEFORE RETURNING ANY PRODUCT TO US. IN THE MEANTIME, WE ARE BACKORDERING QUICK-FIT ORDERS AND/OR SUGGESTING A SUBSTITUTE.