MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2018-01-17 for PHILIPS ZOOM ZM2666 manufactured by Discus Dental, Llc.
[97632049]
Discus dental received a complaint on 12/21/2017 in which patient's upper and lower lips were burned after in-office zoom teeth whitening procedure. The dentist stated that the patient did not have the four (4) front teeth, and the retractor did not fit in the patient's mouth. Dental hygienist used goggles to cover the lips during the whitening procedure. No information was provided if medical treatment was required after the incident. Investigation: - the retain sample of the in-office whitening gel, sku: (b)(4), lot: 16035011 was tested on 01/02/2018 and results were within specifications. - reviewed device history records of zoom whitening kit, sku: (b)(4), lot: 16043036, and whitening gel, sku: (b)(4), lot: 16035011 and no out of specification or discrepancy was found in the records. The bill of material shows that 2 retractors with standard and small sizes were provided with the kit. - reviewed direction for use provided with the device. Dfu describes the warnings and precautions and steps for proper lip isolation - reviewed complaints history, no other similar incidents were reported with the same lot numbers. - based on the investigation results and available information, it can be concluded that there was no failure and malfunction in the device. Potential causes may be improper lips isolation prior to the procedure and not following the instructions provided in the dfu. Based on the complaint description and investigation results, no product failure and out of specification was found. Dfu is adequate and no corrective action is needed. Product was used up during the procedure.
Patient Sequence No: 1, Text Type: N, H10
[97632050]
Discus dental received a complaint on 12/21/2017 in which patient's upper and lower lips were burned after in-office zoom teeth whitening procedure. The dentist stated that the patient did not have the four (4) front teeth, the retractor did not fit in the patient's mouth, and the dental hygienist used goggles to cover the lips during the whitening procedure. No information was provided if medical treatment was required after the incident.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1000582314-2018-00001 |
| MDR Report Key | 7202588 |
| Report Source | HEALTH PROFESSIONAL |
| Date Received | 2018-01-17 |
| Date of Report | 2018-01-17 |
| Date of Event | 2017-12-20 |
| Date Mfgr Received | 2017-12-21 |
| Device Manufacturer Date | 2016-02-22 |
| Date Added to Maude | 2018-01-17 |
| 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 | 0 |
| Initial Report to FDA | 0 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. SANJAY PATEL |
| Manufacturer Street | 1700 A SOUTH BAKER AVE |
| Manufacturer City | ONTARIO CA 91761 |
| Manufacturer Country | US |
| Manufacturer Postal | 91761 |
| Manufacturer Phone | 9095703508 |
| Manufacturer G1 | DISCUS DENTAL, LLC |
| Manufacturer Street | 1700 A SOUTH BAKER AVE |
| Manufacturer City | ONTARIO CA 91761 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 91761 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | PHILIPS ZOOM |
| Generic Name | ZOOM CHAIRSIDE WHITENING KIT |
| Product Code | EEG |
| Date Received | 2018-01-17 |
| Model Number | ZM2666 |
| Lot Number | 16043036 |
| Device Expiration Date | 2017-03-27 |
| Operator | DENTAL HYGIENIST |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DISCUS DENTAL, LLC |
| Manufacturer Address | 1700 A SOUTH BAKER AVE ONTARIO CA 91761 US 91761 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2018-01-17 |