DAMON UTILITY OPENING/CLOSING PLIER * 866-4006

MAUDE Adverse Event Report

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 * 866-4006 manufactured by Ormco Corp..

Event Text Entries

[669920] 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


[7958774] There were no reported injuries associated with this incident. However, due to the prior submission of a reportable incident on the damon plier in 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


MAUDE Entry Details

Report Number2016150-2007-00010
MDR Report Key865950
Report Source05
Date Received2007-03-21
Date of Report2007-02-28
Date of Event2007-02-01
Date Mfgr Received2007-02-28
Device Manufacturer Date2001-01-01
Date Added to Maude2007-06-18
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location0
Manufacturer ContactWENDY URTEL
Manufacturer Street1717 WEST COLLINS AVENUE
Manufacturer CityORANGE CA 92867
Manufacturer CountryUS
Manufacturer Postal92867
Manufacturer Phone7145167602
Manufacturer G1ORMCO CORPORATION
Manufacturer Street1332 SOUTH LONE HILL AVENUE
Manufacturer CityGLENDORA CA 91740
Manufacturer CountryUS
Manufacturer Postal Code91740
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameDAMON UTILITY OPENING/CLOSING PLIER
Generic NamePLIER, ORTHODONTIC
Product CodeJEX
Date Received2007-03-21
Returned To Mfg2007-02-28
Model Number*
Catalog Number866-4006
Lot Number01A40
ID Number*
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device Eval'ed by MfgrN
Implant FlagN
Date Removed*
Device Sequence No1
Device Event Key847927
ManufacturerORMCO CORP.
Manufacturer Address1332 SOUTH LONE HILL AVENUE GLENDORA CA 91740 US


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2007-03-21

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