MAUDE Adverse Event Report: PRISMATIK DENTALCRAFT, INC. ASTRON CLEAR SPLINT; ASTRON CLEAR SPLINTS

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problem Hypersensitivity/Allergic reaction (1907)

Event Date 07/14/2021

Event Type  Injury  

Manufacturer Narrative

The device has not been returned.If/when the device is returned an investigation will be carried out and a supplemental report will be submitted.The patients weight is not provided as it is not taken at the time of the appointment.

Event Description

It was reported that the patient had a reaction to the astron clear splint.The patient first used the device on (b)(6) 2021 and experienced the "burning sensation" on (b)(6) 2021.The provider notes that the reaction was immediate.It is unclear when the patient discontinued the use of the device.The patient did not require medical treatment other than the discontinuation of the device.The patient did not see an allergist prior to the delivery of the device but was referred one on the (b)(6) 2021.The patient has of a hypothyroidism and has been prescribed synthroid.With regard to the device: the device was rinsed with warm water prior to delivery.It is unknown how the patient cared for the device.The device has been returned per the provider.

Manufacturer Narrative

The device investigation has been completed and the results are as follows: dhr results: dhr not applicable.Device is fabricated per physician's prescription only.Stock product reviewed results: no stock product was available for review since the device was fabricated per physician's prescription only.Investigation methods/results: complaint investigator reviewed the returned device.An upper tray was returned in the original case.The results were summarized: roughness - the flange was smooth.Interior/exterior surfaces were smooth.Crack - no major crack was found.Delamination - layers were intact and did not separate.Discoloration - the device was not discolored; appeared clear and transparent.General cleanliness - the returned device appeared to be clean, free of debris or foreign particles.The returned device was visually inspected and no defect or abnormality was observed.There was no evidence found to indicate that the reported issue was caused by the device itself.Root cause: a root cause for this complaint cannot be explicitly determined.Ifu 012579 rev 1.0 (clearsplint instruction for use) states "brush and floss before using clearsplint.After use, rinse the bite splint with water and store dry.Clean bite splint with soap and warm water only." ifu 012579 provides warning "do not clean or soak in mouthwash; do not use denture cleanser; do not place do not place the clearsplint in hot or boiling water or expose to excessive heat (such as direct sunlight).This may distort the appliance; do not use alcohol or hydrogen peroxide." it is possible that reactions could be caused by mouthwash, toothpaste, or soaking material.However, the customer did not provide the information regarding how the patient handled and maintained the device.Per the reported information, the patient has allergies to: latex, vinyl, sulfa, cipro, k-flex, polyurethane, methyl acetate and ethyl acetate.Additionally, the doctor noted the patient has a medical history of gait instability, neuropathy and neuromuscular damage and environmental allergies.Per (b)(6) rev.1.0 (clearsplint biocompatibility report), the device materials have been found to be biocompatible through the testing.There was no cytotoxic, sensitization, skin irritation, or oral mucosal irritation found in any of the test articles.

• Brand Name: ASTRON CLEAR SPLINT
• Type of Device: ASTRON CLEAR SPLINTS
• Manufacturer (Section D): PRISMATIK DENTALCRAFT, INC.; 2144 michaelson drive; irvine CA 92612
• Manufacturer (Section G): PRISMATIK DENTALCRAFT, INC.; 2144 michelson drive; irvine CA 92612
• Manufacturer Contact: herbert crane ; 2144 michelson drive; suite 25; irvine, CA 92612 ; 9495021907
• MDR Report Key: 12280272
• MDR Text Key: 265148022
• Report Number: 3011649314-2021-00289
• Device Sequence Number: 1
• Product Code: MQC
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K111828
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional
• Reporter Occupation: Dentist
• Type of Report: Initial,Followup
• Report Date: 12/27/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/05/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Lay User/Patient
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 11/24/2021
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 07/09/2021
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Reuse
• Patient Sequence Number: 1
• Patient Age: 52 YR
• Patient Sex: Female
• Patient Race: White