MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2007-03-21 for DAMON UTILITY OPENING/CLOSING PLIER * 066-4007 manufactured by Ormco Corp..
[603242]
In 2007, a doctor informed ormco corporation that a damon opening/closing plier had a broken tip insert, braze failure.
Patient Sequence No: 1, Text Type: D, B5
[7875239]
There were no reported injuries associated with this incident. However, due to the prior submission of a reportable incident on the damon plier on may 13, 2005 (mdr# 2016150-2005-00001: malfunction which led to a serious injury), this incident is reportable. This incident falls under the fda presumption that this type of malfunction is likely to cause or contribute to a death or serious injury if the malfunction were to recur.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2016150-2007-00011 |
| MDR Report Key | 833978 |
| Report Source | 05 |
| Date Received | 2007-03-21 |
| Date of Report | 2007-02-21 |
| Date of Event | 2007-02-01 |
| Date Mfgr Received | 2007-02-21 |
| Device Manufacturer Date | 2004-02-01 |
| Date Added to Maude | 2007-04-05 |
| 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 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 0 |
| Manufacturer Contact | WENDY URTEL |
| Manufacturer Street | 1717 W. COLLINS AVE. |
| Manufacturer City | ORANGE CA 92867 |
| Manufacturer Country | US |
| Manufacturer Postal | 92867 |
| Manufacturer Phone | 7145167602 |
| Manufacturer G1 | ORMCO CORPORATION |
| Manufacturer Street | 1332 SOUTH LONE HILL AVENUE |
| Manufacturer City | GLENDORA CA 91740 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 91740 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | DAMON UTILITY OPENING/CLOSING PLIER |
| Generic Name | PLIER, ORTHODONTIC |
| Product Code | JEX |
| Date Received | 2007-03-21 |
| Returned To Mfg | 2007-03-01 |
| Model Number | * |
| Catalog Number | 066-4007 |
| Lot Number | 04B2 |
| ID Number | * |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Eval'ed by Mfgr | N |
| Implant Flag | N |
| Date Removed | * |
| Device Sequence No | 1 |
| Device Event Key | 821301 |
| Manufacturer | ORMCO CORP. |
| Manufacturer Address | 1332 SOUTH LONE HILL AVE. GLENDORA CA 91740 US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2007-03-21 |