KALSOGEN PLUS
Received Nov 11, 2016 · Event occurred Jun 20, 2016
Report 8010638-2016-00006 · MDR key 6095037
Device
Generic name
Cement, Dental
Manufacturer
Dentsply Detrey GmbhModel number
NACatalog number
61115201
Lot number
UNK
Product problems
- Patient-Device Incompatibility
- Patient-Device Incompatibility
- Adverse Event Without Identified Device or Use Problem
Patient
41 YR
- Hypersensitivity/Allergic reaction
- Reaction
- Hypersensitivity/Allergic reaction
- Reaction
Narrative
Additional Manufacturer Narrative
WHILE IT IS UNKNOWN IF THE DEVICE USED IN THIS CASE CAUSED OR CONTRIBUTED TO THE PATIENT'S SYMPTOMS, IT IS POSSIBLE AS ALLERGIC REACTIONS TO DENTAL MATERIALS ARE KNOWN AND REPORTED, WITH MEDICAL CONSEQUENCES BEING DEPENDENT UPON THE SEVERITY OF THE INDIVIDUAL ALLERGIC RESPONSE AND SUBSEQUENT EXPOSURE TO THE SAME MATERIAL. PLEASE NOTE THAT WHILE THIS PRODUCT IS NOT SOLD IN THE US, IT IS CONSIDERED SIMILAR TO PRODUCTS THAT ARE. THE DEVICE IS AVAILABLE FOR EVALUATION, THOUGH HAS NOT BEEN RETURNED AS OF THIS REPORT. EVALUATION RESULTS WILL BE SUBMITTED AS THEY BECOME AVAILABLE.
Description of Event or Problem
IT WAS REPORTED THAT A PATIENT EXPERIENCED AN ALLERGIC REACTION TO KALSOGEN PLUS DENTAL CEMENT. THE SYMPTOMS REPORTED INCLUDED BOWEL IRRITATIONS AND HEAD ITCHING. AFTER REMOVING THE MATERIAL, THE PATIENT IS "GETTING BETTER."
Additional Manufacturer Narrative
BOTH THE RETURNED PRODUCT AND RETAIN PRODUCT HAVE BEEN EVALUATED. THE RETAIN SAMPLE MEETS SPECIFICATION. THE LIQUID OF THE RETURNED SAMPLE HAS BECOME BROWN AND THE BOTTLE WAS NEARLY EMPTY. THE POWDER IS HUMID. IT APPEARS THE RETURNED SAMPLE WAS NOT STORED ACCORDING TO INSTRUCTIONS.