MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2018-06-19 for SYBRONENDO manufactured by Sybronendo.
[112042451]
No patient information was provided in regards to ethnicity, and race. No information was provided in regards to the catalog number and serial number, therefore device manufacturing date could not be determined. Follow up attempts were made to contact the office to find out the status of the patient on (b)(6) 2018, (b)(6) 2018, however there was no response. The product has been identified as a potential affected product in an ongoing class ii recall; therefore no further evaluation is necessary.
Patient Sequence No: 1, Text Type: N, H10
[112042452]
An alleged incident was reported that a patients lip was burned by buchanan heat plugger. It was reported that the patients lip was tender with some swelling and the patient was going to return on (b)(6) 2018 to the office.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2016150-2018-00021 |
| MDR Report Key | 7616682 |
| Report Source | HEALTH PROFESSIONAL |
| Date Received | 2018-06-19 |
| Date of Report | 2018-06-19 |
| Date of Event | 2018-04-24 |
| Date Mfgr Received | 2018-06-19 |
| Date Added to Maude | 2018-06-19 |
| 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 |
| Reporter Occupation | DENTIST |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. PAULO CALLE |
| Manufacturer Street | 1717 W COLLINS AVENUE |
| Manufacturer City | ORANGE CA 92867 |
| Manufacturer Country | US |
| Manufacturer Postal | 92867 |
| Manufacturer Phone | 7145167752 |
| Manufacturer G1 | SYBRONENDO |
| Manufacturer Street | 1332 SOUTH LONE HILL AVENUE |
| Manufacturer City | GLENDORA CA 91740 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 91740 |
| Single Use | 3 |
| Remedial Action | RC |
| Previous Use Code | 3 |
| Removal Correction Number | Z-0413-2018 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SYBRONENDO |
| Generic Name | BUCHANAN HEAT PLUGGER |
| Product Code | EKR |
| Date Received | 2018-06-19 |
| Operator | DENTIST |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | SYBRONENDO |
| Manufacturer Address | 1332 SOUTH LONE HILL AVENUE GLENDORA CA 91740 US 91740 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-06-19 |