MAUDE MDR 2754659

MDR report key
2754659
Report number
2410375-2012-00002
Event key
0
Event type
3
Date received
2012-09-20
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Address
P.O. BOX 9001 SHIRLEY NY 11967 US
Phone
631-631-6319
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1GEM 215NONELUITPOLD PHARMACEUTICALS, INC.NPZUNKR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12012-09-2001. R

Event Narratives#

N

Patient 1

ON (B)(6) 2012, ADDITIONAL INFORMATION 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) RANGE. MEDICAL HISTORY AND CONCOMITANT MEDICATIONS WERE NOT KNOWN. THE PATIENT HAD A LARGE ANTERIOR DEFECT OF TOOTH #7 REQUIRING BULK TISSUE IN THAT AREA OF PREPARATION FOR A BRIDGE. ON AN UNSPECIFIED DATE GEM 215 WAS PLACED ALONG WITH A "CT GRAFT" (CONNECTIVE TISSUE GRAFT) (MEDRA CODED OFF LABEL USE). THE PATIENT DID WELL FOR THE NEXT 5 DAYS AND THEN SWELLING DEVELOPED (AREA NOT SPECIFIED). ANTIBIOTICS WERE PRESCRIBED AND THE PATIENT 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 PATIENT HAVE A FULL RANGE OF BLOOD WORK COMPLETED. RESULTS, SHE REPORTED, WERE "BASICALLY NORMAL" WITH THE EXCEPTION OF AN ELEVATED GLUCOSE LEVEL. THE PATIENT WAS NOT KNOWN TO HAVE A HISTORY OF DIABETES AND WAS QUESTIONED BY THE DENTAL PROVIDER ABOUT THE ABNORMAL LAB VALUE. IN FOLLOW UP THE PATIENT REPORTED THAT HE HAD EATEN A DONUT PRIOR TO SUBMITTING BLOOD FOR THE LAB WORK. AS OF (B)(6) 2012, THE PATIENT WAS 4-5 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 INFORMATION WAS NOT PROVIDED.

D

Patient 1

ON (B)(6) 2012, A SPONTANEOUS REPORT WAS RECEIVED BY LUITPOID PHARMACEUTICALS INC. VIA THE ADF LINE FROM A DENTAL PROVIDER INVOLVING GEM 215. THE DENTAL PROVIDER STATED SHE HAD AN ADVERSE SURGICAL OUTCOME WITH GEM 215. NO ADDITIONAL INFORMATION WAS REPORTED.