MAUDE Adverse Event Report: DENTSPLY MAILLEFER K-FILE M-ACCESS; FILE, PULP CANAL, ENDODONTIC

Catalog Number A12MA02500812

Device Problems Break (1069); Material Discolored (1170); Fracture (1260); Compatibility Problem (2960); Packaging Problem (3007)

Patient Problems No Known Impact Or Consequence To Patient (2692); No Information (3190)

Event Type  malfunction  

Manufacturer Narrative

Since separation of a file could necessitate medical/surgical intervention to preclude permanent damage to a body structure or permanent impairment of a body function, this malfunction would be likely to cause/contribute to a serious injury should it recur.As such, this event meets the criteria for reportability per 21 cfr part 803.This report is for the first file.The device is available for evaluation, though results are not available as of this report.Evaluation results will be submitted as they become available.

Event Description

In this event a customer reported that two k-files did not exhibit the characteristics of our product because they fractured, are irregular sizes, have faded color plastic handle, and had a different label with our identification.Additional information has been requested, but is not yet available.

Manufacturer Narrative

After analysis, the returned file does not meet maillefer quality standards and is obviously counterfeit.Moreover, the batch number has no corresponding with the reference (b)(4) in our system.The container and its labelling are equally recognized as fakes.

• Brand Name: K-FILE M-ACCESS
• Type of Device: FILE, PULP CANAL, ENDODONTIC
• Manufacturer (Section D): DENTSPLY MAILLEFER; chemin du verger 3; ballaigues, 1338 ; SZ 1338
• Manufacturer (Section G): DENTSPLY MAILLEFER; chemin du verger 3; ballaigues, 1338 ; SZ 1338
• Manufacturer Contact: helen lewis ; 221 w. philadelphia st.; suite 60w; york, PA 17401 ; 7178494229
• MDR Report Key: 5138440
• MDR Text Key: 28352823
• Report Number: 8031010-2015-00048
• Device Sequence Number: 1
• Product Code: EKS
• Combination Product (y/n): N
• Reporter Country Code: BR
• PMA/PMN Number: NA
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: foreign,health professional
• Reporter Occupation: Dentist
• Type of Report: Initial,Followup
• Report Date: 09/09/2015

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/08/2015
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Catalogue Number: A12MA02500812
• Device Lot Number: 2350190
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/25/2015
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 10/22/2015
• Was Device Evaluated by Manufacturer?: No
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1