MAUDE Adverse Event Report: MARUS LUXSTAR UNIT MOUNT LIGHT; DENTAL OPERARTING LIGHT

Model Number UL1000

Device Problem Device Maintenance Issue (1379)

Patient Problem Superficial (First Degree) Burn (2685)

Event Date 04/27/2015

Event Type  malfunction  

Event Description

A dental professional was performing routine medical treatment to a patient when the lens head shield/holder fell off the marus dental light and hit the patient on the neck causing a slight burn.There was no serious injuries reported.

Manufacturer Narrative

The lens heat shield/holder from the dental light has a three prong locking mechanism which locks the lens heat shield/holder into place.The lens heat shield/holder has to be removed by the end user when cleaning the lens or replacing the halogen bulb during routine operator maintenance.The installation instructions, use and care instructions, and labeling clearly state to ensure the lens heat shield/holder is properly secure by snapping the part back into place.The light is over 11 years old and is past the expected life of the device.

• Brand Name: LUXSTAR UNIT MOUNT LIGHT
• Type of Device: DENTAL OPERARTING LIGHT
• Manufacturer (Section D): MARUS; 11727 fruehauf dr.; charlotte NC 28273
• Manufacturer Contact: frank ray ; 11727 fruehauf dr.; charlotte, NC 28273 ; 7045877227
• MDR Report Key: 4801706
• MDR Text Key: 5916459
• Report Number: 1017522-2015-00009
• Device Sequence Number: 1
• Product Code: EAZ
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,User Facility
• Reporter Occupation: Dentist
• Type of Report: Initial
• Report Date: 04/28/2015

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 05/27/2015
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: UL1000
• Device Catalogue Number: UL1000
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 04/28/2015
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 10/01/2003
• 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: 21 YR