MAUDE MDR 5183918

MDR report key
5183918
Report number
1416605-2015-00003
Event key
0
Event type
3
Date of event
2015-08-10
Date received
2015-10-28
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
116
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MRS. MARIA VRABIE
Address
3232 N ROCKWELL ST CHICAGO IL 60618 US
Phone
773-773-7738
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1HU-FRIEDY678-101LHU-FRIEDY MFG. CO., LLCEIX678-101L678-101L0312Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12015-10-2801. O

Event Narratives#

N

Patient 1

THE INTENDED USE OF THE 678-101L ORTHODONTIC DISTAL END CUTTER IS TO CUT ORTHODONTIC WIRE AT THE DISTAL END OF THE ORAL CAVITY AND HOLD THE WIRE IN THE CUTTING BLADE WHILE THE JAWS ARE ENGAGED, UNTIL THE INSTRUMENT IS REMOVED FROM THE ORAL CAVITY. THE CUSTOMER STATED THE CUTTER INVOLVED IN THIS INCIDENT DID NOT HOLD THE WIRE DUE TO A LARGER GAP ON A PORTION OF THE CUTTING BLADE, WHICH CAUSED THE ORTHODONTIC WIRE TO EMBED INTO THE PATIENT'S CHEEK. THERE WAS AN INJURY REQUIRING THE PATIENT TO SEE AN ORAL SURGEON. THE CUSTOMER STATED THAT THERE SEEMED TO BE A LARGE "CURVE" CAUSING THE LACK OF WIRE-HOLDING ABILITY. THE INSTRUMENT WAS RETURNED TO HU-FRIEDY FOR EVALUATION. THE EVALUATION REVEALED THAT THE CUSTOMER'S OBSERVATION WAS CORRECT, AND THAT THE CUTTING SURFACES DID NOT MATE CORRECTLY. THEREFORE, THE WIRE DID NOT HOLD IN THE JAWS. THE CUTTING SURFACES NOT MATING PROPERLY WAS CAUSED BY IMPROPER SHARPENING TAKING PLACE DURING SERVICING OF THE INSTRUMENT, WHICH OCCURED AT HU-FRIEDY IN APRIL OF 2015. THIS MALFUNCTION WAS NOT PART OF THE ORIGINAL MANUFACTURING PROCESS, BUT A RESULT OF A SERVICING PROCESS ON LIMITED ITEMS. IN ADDITION, THE INSTRUMENT APPEARS TO BE HEAVILY USED BY THE PRACTITIONER AS INDICATED BY THE DULL CONDITION AT TIPS, WHICH MAY HAVE CONTRIBUTED TO THE ABILITY OF THE INSTRUMENT TO PERFORM AS INTENDED. HU-FRIEDY DOES NOT TRACK OUR DEVICES (WHICH ARE MOSTLY LOW RISK CLASS 1 DEVICES) BY SERIAL NUMBER, ONLY BY A LOT NUMBER, WHICH IS TIED TO THE DATE OF MANUFACTURE. THE PRODUCT INVOLVED IN THE EVENT WAS A STAINLESS STEEL INSTRUMENT THAT DOES NOT HAVE AN EXPIRATION DATE. THE DEVICE IS NOT IMPLANTED, THEREFORE IMPLANT/EXPLANT DATES ARE NOT APPLICABLE.

D

Patient 1

CUSTOMER STATED THE CUTTERS THAT HE WAS USING CAUSED THE WIRE TO DEFLECT INTO A PATIENT'S CHEEK. THERE WAS AN INJURY REQUIRING A PATIENT TO HAVE TO SEE AN ORAL SURGEON.