SYBRONENDO 952-0005

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2018-07-27 for SYBRONENDO 952-0005 manufactured by Sybronendo.

Event Text Entries

[115376069] No patient information was provided in regards to age, gender, ethnicity, and race. Date of event was not provided. Follow up attempts were made for additional information, 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


[115376070] An alleged complaint was reported that the buchanan plugger overheated the gutta percha and it got into the nasal cavity of the patient.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number2016150-2018-00049
MDR Report Key7728915
Report SourceHEALTH PROFESSIONAL
Date Received2018-07-27
Date of Report2018-07-27
Date Mfgr Received2018-07-27
Device Manufacturer Date2018-05-18
Date Added to Maude2018-07-27
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationDENTIST
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMR. PAULO CALLE
Manufacturer Street1717 W COLLINS AVENUE
Manufacturer CityORANGE CA 92867
Manufacturer CountryUS
Manufacturer Postal92867
Manufacturer Phone7145167752
Manufacturer G1SYBRONENDO
Manufacturer Street1332 SOUTH LONE HILL AVENUE
Manufacturer CityGLENDORA CA 91740
Manufacturer CountryUS
Manufacturer Postal Code91740
Single Use3
Remedial ActionRC
Previous Use Code3
Removal Correction NumberZ-0413-2018
Event Type3
Type of Report3

Device Details

Brand NameSYBRONENDO
Generic NameBUCHANAN HEAT PLUGGER
Product CodeEKR
Date Received2018-07-27
Catalog Number952-0005
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerSYBRONENDO
Manufacturer Address1332 SOUTH LONE HILL AVENUE GLENDORA CA 91740 US 91740


Patients

Patient NumberTreatmentOutcomeDate
10 2018-07-27

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