MAUDE MDR 5633760

MDR report key
5633760
Report number
9611253-2014-00006
Event key
0
Event type
3
Date of event
2013-11-20
Date received
2016-05-05
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
MR KENNETH BLOCK
Address
800 E CAMPBELL RD. SUITE 202 RICHARDSON TX 75081 US
Phone
972-972-9724
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1NSK SGA-E2SHANDPIECE, ROTARY BONE CUTTINGNAKANISHI INC.KMWSGA-E2SH265R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12016-05-0501. R

Event Narratives#

N

Patient 1

NAKANISHI INC. AS MANUFACTURER OF THE SGS-E2S DENTAL HANDPIECE IS UNABLE TO CONDUCT AN INVESTIGATION REGARDING THE DEVICE IN THIS EVENT DUE TO: THE DEVICE IN QUESTION WAS NOT RETURNED TO (B)(4), OUR IMPORTER OR TO NAKANISHI INC. DIRECTLY BY THE COMPLAINANT. NO SERIAL NUMBER WAS PROVIDED BY THE COMPLAINANT, SO NO EVALUATION OF THE DEVICE DHR COULD BE CONDUCTED. NAKANISHI CONDUCTED A REVIEW OF THE FDA MAUDE DATABASE AND WAS UNABLE TO LOCATE REPORT 9611253-2014-00006 (THIS REPORT). NAKANISHI BELIEVES THIS REPORT TO HAVE BEEN SUBMITTED PREVIOUSLY; HOWEVER NAKANISHI IS RE-SUBMITTING THIS REPORT TO ENSURE THAT FDA HAS A RECORD OF THE REPORT IN THE MAUDE DATABASE. DEVICE NOT RETURNED BY COMPLAINANT.

D

Patient 1

ON (B)(6) 2014, (B)(4) A NAKANISHI INC. IMPORTER RECEIVED A TELEPHONIC COMPLAINT OF A HANDPIECE ALLEGEDLY CAUSING A BURN TO A PATIENT. COMPLAINANT ONLY PROVIDED THE MODEL NUMBER TO NSK AMERICA. THE SPECIFIC SERIAL NUMBER OF THE DEVICE INVOLVED IN THIS EVENT IS UNKNOWN. THE (B)(4) EMPLOYEE CONTACTED COLLECTED THE FOLLOWING INFORMATION FROM THE DOCTOR: HANDPIECE HEATED UP AND CAUSED A 2ND DEGREE BURN ABOUT 1CM AREA AND HEALING OF THE WOUND LEFT A SLIGHT SCAR. DENTAL PROCEDURE BEING PERFORMED WAS A WISDOM TOOTH EXTRACTION. PATIENT WAS AWAKE UNDER LOCAL ANESTHETIC. HANDPIECE WAS SENT FOR SERVICE BUT NOT SENT TO (B)(4). DOCTOR STATED REASON FOR DELAY IN REPORTING WAS THAT SHE WAS UNABLE TO FIND CONTACT INFORMATION FOR (B)(4). (B)(4) CHECKED THEIR INTERNAL SERVICE RECORDS AND DID NOT LOCATE ANY RECORDS OF THEM PERFORMING ANY REPAIR ACTIVITY FOR THIS DOCTOR. HANDPIECE SERIAL NUMBER WAS NOT KNOWN BY THE DOCTOR AND NO FURTHER RECORD SEARCHES COULD BE PERFORMED TO DETERMINE THE DATE OF SALE OF THE HANDPIECE TO THE DOCTOR. (B)(4) SENT A FOLLOW-UP LETTER REQUESTING ADDITIONAL INFORMATION AND RETURN OF THE HANDPIECE TO DR. (B)(6) ON (B)(6) 2014. AS OF SEPTEMBER 3, 2014 (B)(4) HAS RECEIVED NO RESPONSE FROM THE COMPLAINANT.