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MalfunctionEMR

PROFILE ORIFICE OPENER FILES

Received Jun 29, 2006

Report 2320721-2006-00277 · MDR key 734237

Device

Generic name

Emr

Manufacturer

Dentsply Tulsa

Model number

NA

Catalog number

OS0219

Lot number

SEE H.10

Product problems

  • Device, or device fragments remain in patient
  • Material Separation

Patient

30 YR

  • Nonresorbable materials, unretrieved in body

Narrative

Description of Event or Problem

IT WAS REPORTED THAT A FILE SEPARATED IN THE CANAL DURING A PROCEDURE. THE CANAL WAS FILLED WITH THE SEPARATED PIECE IN PLACE.

Additional Manufacturer Narrative

IN THIS INCIDENT THERE WAS NO REPORT OF INJURY TO THE PATIENT. HOWEVER, AS A RESULT OF THIS MALFUNCTION, THE POTENTIAL FOR SURGICAL INTERVENTION EXISTS (THOUGH INADVISABLE PER EXPERT OPINION PROVIDED BY DR.) TO PRECLUDE INJURY OR ILLNESS THAT WOULD NECESSITATE MEDICAL OR SURGICAL INTERVENTION TO PRECLUDE PERMANENT DAMAGE TO A BODY STRUCTURE OR PERMANENT IMPAIRMENT OF A BODY FUNTION AS EVIDENCED BY PREVIOUS REPORTED EVENTS WITH SIMILAR FILES. THIS EVENT, THEREFORE, IS REPORTABLED PER 21CFR PART 803. THE DEVICE WAS RETURNED FOR EVALUATION, THOUGH RESULTS ARE NOT AVAILABLE AS OF THIS REPORT. EVALUATION RESULTS WILL BE SUBMITTED AS THEY BECOME AVAILABLE. TWO LOT NUMBERS WERE PROVIDED BY THE INITIAL REPORTER: 033006251 (MANUFACTUER 03/30/2006) AND 010406215 (MANUFACTURED 01/04/2006). IT IS UNK WHICH, IF EITHER, WAS INVOLVED IN THE EVENT.