inforMED
MalfunctionEIE

HYGENIC

Received Oct 23, 2018

Report 2416455-2018-00013 · MDR key 7996461

Device

Generic name

Dental Dam

Catalog number

H09105

Lot number

J072568

Product problems

  • Material Integrity Problem
  • Detachment of Device or Device Component
  • Material Integrity Problem
  • Material Split, Cut or Torn

Patient

Not reported

  • No Consequences Or Impact To Patient
  • No Consequences Or Impact To Patient

Narrative

Additional Manufacturer Narrative

ATTACHMENT: (B)(4).

Description of Event or Problem

DURING A ROOT CANAL, THE NON-LATEX DENTAL DAM SPLIT AND CAME OFF OVER CLAMP PATIENT WAS UNAWARE OF WHAT HAPPENED. THIS PRODUCT HAS BEEN USED MANY TIMES BEFORE WITHOUT AN ISSUE. ALL PARTS WERE RETRIEVED AND THERE WAS NO HARM TO THE PATIENT.

Remedial action

  • Replace