ULTRA SAFETY PLUS

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a foreign,health professional report with the FDA on 2019-04-24 for ULTRA SAFETY PLUS manufactured by Septodont.

Event Text Entries

[143237915] Spontaneous report, from (b)(6). Local reference # (b)(4). Quality complaint file was opened; local complaint reference # (b)(4). Quality complaint: # (b)(4). Initial information received by the manufacturer from the (b)(6) on 10-jan-2019 (reference # (b)(4)) reporting information from dental office. The same report was received from (b)(6) on 15-jan-2019. Incident reporting form received on 25-feb-2019 from the dentist. On 22-nov-2019 (noted in incident reporting form but 29-nov-2018 in the (b)(6) report), dental student administered a local anesthetic (trade name not specified) with the suspect device ultra safety plus needle blue 30ga (batch # f51257aa and expiration date: mar-2023). Needle broke on 3 occasions and was withdrawn from patients mouth. No injury was reported. The patients were reassured and all needles from the same batch were withdrawn from clinic. The patients recovered and the dentist did not considered this incident as serious. Additional information is expected. Causality assessment on 28-mar-2019 on initial information received on 10-jan-2019 and on additional information received on 25-feb-2019: seriousness: serious. Expectedness: needle issue: unexpected eu/ca/us. No adverse event: expected eu/ca/us. Causality: latency: compatible. Recognized association: no. Analysis - a dental student reported needle breakage while using the device in patients. The possible causes for the reported event may be the bending of the needle before use, excessive pressure or movement of the needle during injection, a sudden movement of the patient during injection, the use of a needle size inappropriate to the type of procedure and/or quality defect of the needle. At the time of this report, information are not sufficient to identify a misuse or inappropriate usage during the local injection and to conclude. Quality investigation is ongoing; pending the results, the case report was considered as not assessable. Concluded causality who: not assessable.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number9610964-2019-00001
MDR Report Key8546893
Report SourceFOREIGN,HEALTH PROFESSIONAL
Date Received2019-04-24
Date of Report2019-05-29
Date of Event2018-11-22
Date Mfgr Received2019-04-29
Date Added to Maude2019-04-24
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional0
Initial Report to FDA0
Report to FDA3
Event Location3
Manufacturer Street58, RUE DU PONT DE CRETEIL
Manufacturer CitySAINT MAUR DES FOSSESS, 94107
Manufacturer CountryFR
Manufacturer Postal94107
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameULTRA SAFETY PLUS
Generic NameULTRA SAFEY PLUS
Product CodeDZM
Date Received2019-04-24
Lot NumberF51257AA
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerSEPTODONT
Manufacturer Address58, RUE DU PONT DE CRETEIL SAINT MAUR, CEDEX VAL-DE-MARNE, 94107 FR 94107


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 2019-04-24

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