MAUDE MDR 6123486

MDR report key
6123486
Report number
1000582314-2016-00008
Event key
0
Event type
3
Date of event
2016-06-01
Date received
2016-11-22
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
301
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MR. SANJAY PATEL
Address
1700 A S BAKER AVE ONTARIO CA 91761 US
Phone
909-909-9095
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1PHILIPS ZOOMZOOM CHAIRSIDE WHITENING KIT AND GELDISCUS DENTAL, LLCEEG22-376415232022R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12016-11-2201. O

Event Narratives#

N

Patient 1

DISCUS DENTAL RECEIVED A COMPLAINT ON 10/25/2016. THE PATIENT COMPLETED IN-OFFICE TEETH WHITENING PROCEDURE, AND SINCE THEN SHE IS EXPERIENCING TOOTH LINGERING SENSITIVITY. THE PATIENT VISITED A SPECIALIST FOR EVALUATION, WHO FOUND NOTHING WRONG. AFTER RECEIVING THIS REPORT, RETAIN SAMPLE OF THE WHITENING GEL, LOT: 15232022, WAS TESTED AND THE RESULTS WERE WITHIN SPECIFICATIONS. THE GEL AND KIT WERE USED DURING THE PROCEDURE, AND WERE NOT RETURNED. BATCH HISTORY RECORD OF WHITENING GEL SKU: 22-3764, LOT: 15232022 WAS REVIEWED, AND NO OUT OF SPECIFICATIONS, NON-CONFORMANCE OR DISCREPANCY WAS FOUND. REVIEWED COMPLAINT HISTORY. NO OTHER COMPLAINTS WERE RECEIVED WITH THE SAME LOT NUMBER. BASED ON THE INVESTIGATION RESULTS, NO PRODUCT FAILURE OR MALFUNCTION WAS DETECTED. DENTAL OFFICE INFORMED THAT THE PATIENT HAD SCALING AND ROOT PLANNING (SRP) ONE MONTH BEFORE THE WHITENING PROCEDURE. WITH THE AVAILABLE INFORMATION, IT CAN BE CONCLUDED THAT, PRE-EXISTING SENSITIVITY MAY HAVE CONTRIBUTED TO THE LINGERING TEETH SENSITIVITY. IT IS ALSO PLAUSIBLE THAT SCALING AND ROOT PLANNING PRIOR TO THE WHITENING MIGHT HAVE ENHANCED THE SENSITIVITY EXPERIENCE. DFU IS ADEQUATE. PRE-TREATMENT AND POST TREATMENT FOR SENSITIVITY ARE DESCRIBED IN DFU. NO CORRECTIVE ACTION IS REQUIRED. IT ALSO INCLUDES WARNINGS, PRECAUTIONS, AND CANDIDATE QUALIFICATION. DISCUS DENTAL WILL CONTINUE TO MONITOR SIMILAR COMPLAINTS. THE WHITENING KIT AND GEL WERE USED.

D

Patient 1

DISCUS DENTAL RECEIVED A COMPLAINT ON 10/25/2016. THE PATIENT COMPLETED IN-OFFICE TEETH WHITENING PROCEDURE, AND SINCE THEN, SHE IS EXPERIENCING TOOTH LINGERING SENSITIVITY. THE PATIENT VISITED A SPECIALIST FOR EVALUATION, WHO FOUND NOTHING WRONG.