MAUDE MDR 3551144

MDR report key
3551144
Report number
1925223-2014-00002
Event key
0
Event type
3
Date received
2014-01-03
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
301
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
MS. AUDI BOGUCKI
Address
300 HERAEUS WAY SOUTH BEND IN 46614 US
Phone
574-574-5742
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1IVORY CLAMPEEF CLAMP, RUBBER DAMHERAEUS KULZER LLCEEF12A50057348I3Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-01-030

Event Narratives#

D

Patient 1

RECEIVED EMAIL FROM DEALER THAT THEY RECEIVED A CLAMP THAT BROKE ON FIRST USE. SPOKE TO AT THE DENTAL ASSISTANT AT THE OFFICE. SHE SAID THAT THIS CLAMP WAS NEW. SHE SAID THAT THE DENTIST WAS WORKING ON THE PATIENT AND IT SNAPPED. SHE SAID THAT NO ONE WAS INJURED. SHE DID NOT REMEMBER THE PATIENT OR WHAT DAY IT HAPPENED ON. SHE SAID THE DENTIST MIGHT. SHE TOOK A MESSAGE WITH CONTACT INFORMATION AND SAID SHE WOULD SEE IF HE HAD ANYTHING TO ADD. CALLED BACK LATER AND LEFT A MESSAGE FOR THE DENTIST TO CALL BACK. NO RESPONSE TO DATE.

N

Patient 1

ALTHOUGH WE HAVE NOT ESTABLISHED THAT THE DEVICE CAUSED OR CONTRIBUTED TO THE EVENT, WE'RE REPORTING IT TO BE COMPLIANT WITH 21 CFR PART 803 AND OUT OF AN ABUNDANCE OF CAUTION. NARRATIVE FOR CONCLUSION - THE CLAMP HAS SIGNS OF EROSION EVEN THOUGH THE COMPLAINT IS THAT THE CLAMP WAS NEW AND ONLY USED ONCE. THE CLAMP WAS THEREFORE EXPOSED TO EXCESSIVE HEAT AND ACIDS TO CAUSE THE DAMAGE. THE DIRECTIONS FOR USE STATES, "INSPECT AND STERILIZE CLAMP BEFORE EACH USE. FOR OPTIMUM USE, USE A GENERAL-PURPOSE CLEANER PRIOR TO STERILIZATION. DO NOT HEAT CLAMP ABOVE 350?F/177?C." NARRATIVE FOR CONCLUSION - DEVICE BREAKAGE IS ADDRESSED IN THE DIRECTIONS FOR USE. THE DIRECTIONS STATE, "DO NOT PLACE CLAMP IN MOUTH UNTIL THE RUBBER DAM HAS BEEN PROPERLY PLACED. CLAMP COULD BECOME A CHOKING OR SAFETY HAZARD IF DROPPED OR BROKEN IN THE MOUTH WITHOUT PROPER USE OF THE RUBBER DAM AT ALL TIMES." NARRATIVE FOR CONCLUSION - THE DIRECTIONS FOR USE WARNS, "CAUTION: MODIFICATION, OVER-EXTENDING, BENDING, OR USE EXCEEDING ONE YEAR MAY CAUSE BREAKAGE." THE DIRECTIONS CONTAIN ADEQUATE WARNING AND INSTRUCTIONS. THE DENTIST SAID THAT NO ONE WAS INJURED DURING THE INCIDENCE.