MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2017-12-28 for MACHTOU PLUGGER 001/002 V041063001002 manufactured by Dentsply Vdw Gmbh.
[96128657]
Since there has been a previous report received with the same product where this malfunction resulted in a serious injury it must be presumed that recurrence of this malfunction could possibly cause or contribute to a serious injury or require medical or surgical intervention to preclude such. As such, this event is reportable per 21cfr part 803. The device is available for evaluation, though results are not available as of this report. Evaluation results will be submitted as they become available.
Patient Sequence No: 1, Text Type: N, H10
[96128658]
In this event, it was reported that a machtou plugger separated; the broken piece has been retrieved. No injury resulted.
Patient Sequence No: 1, Text Type: D, B5
[118947103]
The active part #1 of the returned plugger is actually broken in the middle depth ring. No material defect was found during analysis of the rupture pattern. Active part #2 is not damaged. Nothing unusual to report was found during dhr review. Root causes are not identified. We will track this kind of event and monitor the trend. For information, msa recommends to do not apply a too high bending force during the use of this instrument.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 9611053-2017-00094 |
| MDR Report Key | 7151150 |
| Date Received | 2017-12-28 |
| Date of Report | 2018-02-23 |
| Date Mfgr Received | 2018-02-19 |
| Date Added to Maude | 2017-12-28 |
| 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 | MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE |
| 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 MAILLEFER |
| Manufacturer Street | CHEMIN DU VERGER 3 |
| Manufacturer City | BALLAIGUES, 1338 |
| Manufacturer Country | SZ |
| Manufacturer Postal Code | 1338 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | MACHTOU PLUGGER 001/002 |
| Generic Name | PLUGGER, ROOT CANAL, ENDODONTIC |
| Product Code | EKR |
| Date Received | 2017-12-28 |
| Returned To Mfg | 2017-11-28 |
| Model Number | NA |
| Catalog Number | V041063001002 |
| Lot Number | 8433910 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DENTSPLY VDW GMBH |
| Manufacturer Address | BAYERWALDSTRASSE 15 MUNICH, 81737 GM 81737 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2017-12-28 |