MAUDE MDR 7960256

MDR report key
7960256
Report number
1416605-2018-00007
Event key
0
Event type
3
Date of event
2018-09-06
Date received
2018-10-12
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
116
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MRS. MARIA VRABIE
Address
3232 N ROCKWELL ST CHICAGO IL 60618 US
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1HU-FRIEDY #11/12R CURETTE RIGIDCURETTE, PERIODONTICHU-FRIEDY MFG. CO. LLCEMSSG11/12R9E2SG11/12R9E20118Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12018-10-1201. O

Event Narratives#

N

Patient 1

WEIGHT OF PATIENT IS UNKNOWN. ETHNICITY OF PATIENT IS UNKNOWN. RACE OF PATIENT IS UNKNOWN. NO KNOWN RELEVANT TESTS OR LABORATORY DATA. NO KNOWN RELEVANT HISTORY. HU-FRIEDY DOES NOT TRACK CLASS 1 DEVICES BY SERIAL NUMBER OR UDI, ONLY BY A LOT NUMBER, WHICH IS TIED TO THE DATE OF MANUFACTURE. THE PRODUCT INVOLVED IN THE EVENT DOES NOT HAVE AN EXPIRATION DATE. THE DEVICE IS NOT IMPLANTED, THEREFORE IMPLANT/EXPLANT DATES ARE NOT APPLICABLE. PREPROCESSOR DOES NOT APPLY. NO CONCOMITANT MEDICAL PRODUCTS OR THERAPY DATES PROVIDED. IND DOES NOT APPLY.

D

Patient 1

IT WAS REPORTED TO HU-FRIEDY THAT A PATIENT WAS BEING TREATED WHEN THE TIP OF AN INSTRUMENT BROKE AND BECAME LODGED IN THE GUM NEAR THE MESIAL OF TOOTH #2.