MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,07 report with the FDA on 2015-04-17 for VECTORTAS MINI SCREW 601-0021 manufactured by Ormco Corporation.
[19093107]
A doctor alleged that one (1) vectortas 8mm mini screw had broken during placement during a patient's procedure.
Patient Sequence No: 1, Text Type: D, B5
[19236798]
Specific patient information such as gender, age, and weight was not provided. The patient was referred to an oral surgeon and the broken part was removed from the patient's mouth. To date, the patient has fully recovered and is doing fine. The product involved in the alleged incident was not returned and no lot number was provided; therefore, no further evaluation can be conducted.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2016150-2015-00016 |
| MDR Report Key | 4704469 |
| Report Source | 05,07 |
| Date Received | 2015-04-17 |
| Date of Report | 2015-02-07 |
| Date Mfgr Received | 2015-02-07 |
| Date Added to Maude | 2015-04-20 |
| 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 | MRS. KERRI CASINO |
| Manufacturer Street | 1717 W COLLINS AVE |
| Manufacturer City | ORANGE CA 92867 |
| Manufacturer Country | US |
| Manufacturer Postal | 92867 |
| Manufacturer Phone | 7145167634 |
| Manufacturer G1 | ORMCO CORPORATION |
| Manufacturer Street | 1332 SOUTH LONE HILL AVENUE |
| Manufacturer City | GLENDORA CA 91740 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 91740 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | VECTORTAS MINI SCREW |
| Generic Name | ENDOSSEOUS DENTAL IMPLANT |
| Product Code | OAT |
| Date Received | 2015-04-17 |
| Catalog Number | 601-0021 |
| Operator | DENTIST |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ORMCO CORPORATION |
| Manufacturer Address | 1332 SOUTH LONE HILL AVENUE GLENDORA CA 91740 US 91740 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other; 2. Required No Informationntervention | 2015-04-17 |