MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a consumer report with the FDA on 2016-05-13 for ALADDIN FLOW UNK manufactured by Dentsply Caulk.
[45192249]
While it is unknown if the device used in this case caused or contributed to the patient's symptoms, it is possible as allergic reactions to dental materials are known and reported, with medical consequences being dependent upon the severity of the individual allergic response and subsequent exposure to the same material. Therefore, this event meets the criteria for reportability per 21 cfr part 803. The device was not returned for evaluation and the lot number was not provided for retained-product testing and/or dhr review.
Patient Sequence No: 1, Text Type: N, H10
[45192250]
It was reported that a patient experienced an allergic reaction to aladdin flow composite material. The patient had a sealant put on her tooth in (b)(6) 2015 and for approximately 1 day she had numbing and a burning sensation in her mouth. On (b)(6) 2016, the patient had a sealant put on another tooth, using the same material. This time, the patient experienced the numbness all around her lips, along with a burning sensation and tightness feeling. She also stated that there was swelling inside her mouth and an area of skin that looks "bleached" (lighter in color) and her eyes were very watery. There was no report of treatment for the reaction as of this mdr evaluation.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2515379-2016-00014 |
| MDR Report Key | 5655168 |
| Report Source | CONSUMER |
| Date Received | 2016-05-13 |
| Date of Report | 2016-04-13 |
| Date Mfgr Received | 2016-04-13 |
| Date Added to Maude | 2016-05-13 |
| 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 | PATIENT |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MRS. HELEN LEWIS |
| Manufacturer Street | 221 W. PHILADELPHIA ST. SUITE 60W |
| Manufacturer City | YORK PA 17401 |
| Manufacturer Country | US |
| Manufacturer Postal | 17401 |
| Manufacturer Phone | 7178494229 |
| Manufacturer G1 | DENTSPLY CAULK |
| Manufacturer Street | 38 W. CLARK AVE. |
| Manufacturer City | MILFORD DE 19963 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 19963 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ALADDIN FLOW |
| Generic Name | CEMENT, DENTAL |
| Product Code | EMA |
| Date Received | 2016-05-13 |
| Model Number | NA |
| Catalog Number | UNK |
| Lot Number | UNK |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DENTSPLY CAULK |
| Manufacturer Address | 38 W. CLARK AVE. MILFORD DE 19963 US 19963 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2016-05-13 |