GEM 215

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 00,05 report with the FDA on 2012-09-20 for GEM 215 manufactured by .

Event Text Entries

[3007370] On (b)(6) 2012, a spontaneous report was received by luitpold pharmaceuticals, inc. Via the ade line from a dental provider involving gem 215. The dental provider stated she had an adverse surgical outcome with gem 215. No additional info was reported. On (b)(6) 2012, additional info was received from the dental provider who did not have the medical record available at the time of the call. This involved a male in the (b)(6) yr range. Medical history and concomitant medications were not known. The pt had a large anterior defect of tooth #7 requiring bulk tissue in that area in preparation for a bridge. On an unspecified date gem 215 was placed along with a "ct graft" (connective tissue graft) (meddra coded off label use). The pt did well for the next 5 days and then swelling developed (area not specified). Antibiotics were prescribed and the pt was followed every 3 days. Approximately 10 days later there was an abscess and the ct graft had sloughed. Two weeks following the procedure, the dental provider requested the pt have a full range of blood work completed. Results, she reported, were "basically normal" with the exception of an elevated glucose level. The pt was not known to have a history of diabetes and was questioned by the dental provider about the abnormal lab value. In f/u the pt reported that he had eaten a donut prior to submitting blood for the lab work. As of (b)(6) 2012, the pt was (b)(6) weeks post procedure and reportedly had completely healed. However, the dental provider reported, "the void is twice as large". There has been bone loss and tissue loss. Treatment info was not provided.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number2915056-2012-00043
MDR Report Key2754640
Report Source00,05
Date Received2012-09-20
Date of Report2012-09-18
Date Mfgr Received2012-08-31
Date Added to Maude2012-09-24
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag0
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location0
Manufacturer StreetPO BOX 9001
Manufacturer CitySHIRLEY NY 11967
Manufacturer CountryUS
Manufacturer Postal11967
Manufacturer Phone6319244000
Single Use0
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameGEM 215
Generic NameNONE
Product CodeNPZ
Date Received2012-09-20
Lot NumberUNK
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 2012-09-20

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