MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2018-10-05 for GUTTAFUSION OBTURATOR OVEN V041500000000 manufactured by Dentsply Vdw Gmbh.
[123209879]
While no serious injury resulted in this event, if this malfunction recurred, it could cause or contribute to a serious injury or require medical or surgical intervention to preclude such. This event, therefore, is reportable per 21cfr part 803. The device is available for evaluation, though has not been returned as of this report. Evaluation results will be submitted as they become available.
Patient Sequence No: 1, Text Type: N, H10
[123209880]
In this event it was reported that a gutta fusion oven, when removing it from the socket only, happened to cause an electric shock; no injury resulted.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9611053-2018-00149 |
| MDR Report Key | 7940272 |
| Date Received | 2018-10-05 |
| Date of Report | 2018-12-04 |
| Date Mfgr Received | 2018-11-12 |
| Date Added to Maude | 2018-10-05 |
| 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. KARL NITTINGER |
| Manufacturer Street | 221 W. PHILADELPHIA ST. SUITE 60W |
| Manufacturer City | YORK PA 17401 |
| Manufacturer Country | US |
| Manufacturer Postal | 17401 |
| Manufacturer Phone | 7178494424 |
| Manufacturer G1 | UNITRON GROUP BV |
| Manufacturer Street | SCHANSESTRAAT 7 |
| Manufacturer City | IJZENDIJKE ZEELAND, 4515 |
| Manufacturer Country | NL |
| Manufacturer Postal Code | 4515 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | GUTTAFUSION OBTURATOR OVEN |
| Generic Name | GUTTA-PERCHA |
| Product Code | EKM |
| Date Received | 2018-10-05 |
| Model Number | NA |
| Catalog Number | V041500000000 |
| Lot Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| 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 | 2018-10-05 |