MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2016-11-11 for KALSOGEN PLUS 61115201 manufactured by Dentsply Detrey Gmbh.
[59766621]
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. Please note that while this product is not sold in the us, it is considered similar to products that are. The device is available for evaluation, though has not been returned as of this report. Evaluation results will be submitted as they become available.
Patient Sequence No: 1, Text Type: N, H10
[59766622]
It was reported that a patient experienced an allergic reaction to kalsogen plus dental cement. The symptoms reported included bowel irritations and head itching. After removing the material, the patient is "getting better. "
Patient Sequence No: 1, Text Type: D, B5
[65252265]
Both the returned product and retain product have been evaluated. The retain sample meets specification. The liquid of the returned sample has become brown and the bottle was nearly empty. The powder is humid. It appears the returned sample was not stored according to instructions.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 8010638-2016-00006 |
| MDR Report Key | 6095037 |
| Date Received | 2016-11-11 |
| Date of Report | 2017-01-18 |
| Date of Event | 2016-06-20 |
| Date Mfgr Received | 2016-12-20 |
| Date Added to Maude | 2016-11-11 |
| 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 |
| 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 DETREY GMBH |
| Manufacturer Street | DETREY STRASSE 1 |
| Manufacturer City | KONSTANZ, 78467 |
| Manufacturer Country | GM |
| Manufacturer Postal Code | 78467 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | KALSOGEN PLUS |
| Generic Name | CEMENT, DENTAL |
| Product Code | EMA |
| Date Received | 2016-11-11 |
| Model Number | NA |
| Catalog Number | 61115201 |
| Lot Number | UNK |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DENTSPLY DETREY GMBH |
| Manufacturer Address | DETREY STRASSE 1 KONSTANZ, 78467 GM 78467 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2016-11-11 |