MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2006-01-12 for APC II VICTORY SERIES LOW PROFILE MBT BRACKET 3024-XXX manufactured by 3m Unitek.
[444464]
Pt experienced a reaction after beginning orthodontic treatment which included a rash and puffy, reddish oral tissues. The braces were removed two months later but symptoms continued. Pt consulted a physician and a dermatology clinical and was given a prescription for a steroid (prednisone). Pt told manufacturer that she is allergic to glue and latex but orthodontist stated that his orthodontic clinic is latex-free. Orthodontist stated that he examined pt in 2006 and saw no evidence of rash. Pt has had no testing done to determine what caused her reaction.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2020467-2006-00001 |
| MDR Report Key | 664610 |
| Report Source | 05 |
| Date Received | 2006-01-12 |
| Date of Report | 2006-01-03 |
| Date Mfgr Received | 2006-01-03 |
| Date Added to Maude | 2006-01-19 |
| 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 | 0 |
| Manufacturer Contact | MARLYN SCHEFF |
| Manufacturer Street | 2724 SOUTH PECK ROAD |
| Manufacturer City | MONROVIA CA 91016 |
| Manufacturer Country | US |
| Manufacturer Postal | 91016 |
| Manufacturer Phone | 6265744496 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | APC II VICTORY SERIES LOW PROFILE MBT BRACKET |
| Generic Name | ADHESIVE PRECOATED ORTHODONTIC BRACKET |
| Product Code | DYW |
| Date Received | 2006-01-12 |
| Model Number | NA |
| Catalog Number | 3024-XXX |
| Lot Number | UNK |
| ID Number | * |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Implant Flag | N |
| Date Removed | * |
| Device Sequence No | 1 |
| Device Event Key | 654018 |
| Manufacturer | 3M UNITEK |
| Manufacturer Address | 2724 SOUTH PECK ROAD MONROVIA CA 91016 US |
| Baseline Brand Name | APC II VICTORY SERIES LOW PROFILES MBT BRACKET |
| Baseline Generic Name | ADHESIVE PRECOATED ORTHODONTIC BRACKET |
| Baseline Model No | NA |
| Baseline Catalog No | 3024-XXX |
| Baseline ID | * |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2006-01-12 |