MAUDE MDR 4168316

MDR report key
4168316
Report number
2032574-2014-00002
Event key
0
Event type
3
Date of event
2014-04-15
Date received
2014-09-19
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
0
Initial report to FDA
0
Event location
0

Manufacturer Contact#

Contact
MORRIS SHERWOOD
Address
6868A CORTONA DR SANTA BARBARA CA 93117 US
Phone
805-805-8059
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1ISODRY SYSTEM AND MOUTHPIECEISODRY SYSTEMINNERLITE SYSTEMSEIFEID0101/CILXX01EID0101/CILXX01R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-09-1901. D

Event Narratives#

D

Patient 1

DOCTOR DID NOT REPORT THIS TO ISOLITE SYSTEMS UNTIL (B)(6) 2014 (5 MONTHS PAST EVENT) - (B)(6) FEMALE CANCER PT RECEIVED DENTAL CROWN PREPARATION/FILLINGS FROM DENTIST IN (B)(6) (USING AN ISODRY SYSTEM AND MOUTHPIECE). PT WAS TREATED WITHOUT INCIDENT. PT WENT HOME AND DIED THE FOLLOWING WEEK.

N

Patient 1

THE DOCTOR SAW THE PT IN (B)(6). HER APPOINTMENT WAS FOR CROWN PREP ON TWO TEETH (#14 AND 15 LEFT SIDE OF THE MOUTH). THE PT WAS DIAGNOSED AND TREATED FOR HEAD AND NECK CANCER IN 2008 (RIGHT SIDE OF THE MOUTH) AND HAD RADIATION TREATMENT. THE DOCTOR STATED HE SEATED THE PT AND PLACED A MOUTHPIECE AND BEGAN PREP OF THE FIRST TOOTH. HE WAS FINISHED WITHIN 30-40 MINUTES THEN HAD HER TAKE A BREAK WHILE HE PREPARED FOR THE SECOND PREP. SHE WAS ABLE TO GET UP AND MOVE AROUND, SAY HELLO TO STAFF MEMBERS, THEN AFTER 15-20 MINUTES CAME BACK TO THE CHAIR FOR FURTHER TREATMENT. HE WAS DONE WITH BOTH CROWN PREPS WITHIN 2 HOURS. THE DOCTOR WAS CONTACTED THE FOLLOWING TUESDAY AFTER THE APPOINTMENT. HE STATED HE WAS TOLD BY THE PT'S DAUGHTER THAT SHE HAD BEEN COMPLAINING OF SORE THROAT AND FEELING HOARSE AFTER HER DENTAL APPOINTMENT. PT WAS ALMOST (B)(6) AT THE TIME OF HER DEATH. ALTHOUGH SHE SEEMED TO BE DOING WELL, SHE HAD A LONG HISTORY OF CANCER AND HEART DISEASE (HAD A TRIPLE BYPASS). THE DEATH IS BEING ATTRIBUTED TO PNEUMONIA. THE PT WAS NEVER SEEN AT THE HOSPITAL, SHE DIED AT HOME IN HER BED. THE DOCTOR SAID THE FAMILY HAD THE PT CREMATED WITHIN TWO WEEKS AND NO AUTOPSY WAS COMPLETED.