MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2013-07-31 for NUPRO PROPHY PASTE 801309 manufactured by Dentsply Professional.
[3641853]
In this event, it was reported that after a pt with multiple allergies completed a prophylaxis cleaning with nupro prophy paste, her lips began to swell. After leaving the dentist office, she became itchy and noticed hives. The pt went to urgent care and received a spectrum/benadryl shot. Her symptoms abated within a half hour.
Patient Sequence No: 1, Text Type: D, B5
[10937047]
While it is unk if the device used in this case caused or contributed to the pt's symptoms, it is possible as allergic reactions to dental materials are known and reported, with medical consequences being dependent upon the severity of the individual allergic response and subsequent exposure to the same material. Therefore, this event meets the criteria for reportability per 21 cfr part 803. The device was evaluated and found to be within specification.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2515379-2013-00034 |
| MDR Report Key | 3280990 |
| Report Source | 05 |
| Date Received | 2013-07-31 |
| Date of Report | 2013-07-02 |
| Date Mfgr Received | 2013-07-02 |
| Date Added to Maude | 2013-08-13 |
| 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 | DENTIST |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | HELEN LEWIS |
| Manufacturer Street | 221 W PHILADELPHIA ST SUSQUEHANNA COMMERCE CENTER W, STE 60 |
| Manufacturer City | YORK PA 17401 |
| Manufacturer Country | US |
| Manufacturer Postal | 17401 |
| Manufacturer Phone | 7178457511 |
| Manufacturer G1 | DENTSPLY CAULK |
| Manufacturer Street | 38 WEST CLARKE AVE. |
| Manufacturer City | MILFORD DE 19963 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 19963 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | NUPRO PROPHY PASTE |
| Product Code | EJR |
| Date Received | 2013-07-31 |
| Returned To Mfg | 2013-07-16 |
| Catalog Number | 801309 |
| Lot Number | UNK |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DENTSPLY PROFESSIONAL |
| Manufacturer Address | YORK PA US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2013-07-31 |