MAUDE Adverse Event Report: TULSA DENTAL PRODUCTS LLC PRO-POST: 6PK DRILL #3; DRILL, DENTAL, INTRAORAL

Catalog Number POSTD3

Device Problem Break (1069)

Patient Problems Insufficient Information (4580); No Clinical Signs, Symptoms or Conditions (4582)

Event Type  malfunction  

Manufacturer Narrative

There has been a previous report received where this malfunction resulted in a serious injury.Therefore, it must be presumed that recurrence of this malfunction could possibly cause or contribute to a serious injury or require medical or surgical intervention to preclude such.As such, this event is reportable per 21cfr part 803.The device is available for evaluation, though has not been returned as of this report.Evaluation results will be submitted as they become available.

Event Description

In this event it was reported that a pro-post drill broke during use.The fragment was retrieved; no injury resulted.

Manufacturer Narrative

Multiple unsuccessful attempts were made to obtain the device for evaluation.

• Brand Name: PRO-POST: 6PK DRILL #3
• Type of Device: DRILL, DENTAL, INTRAORAL
• Manufacturer (Section D): TULSA DENTAL PRODUCTS LLC; 608 rolling hills drive; johnson city TN 37604
• MDR Report Key: 10797575
• MDR Text Key: 217080411
• Report Number: 2320721-2020-00154
• Device Sequence Number: 1
• Product Code: DZA
• Combination Product (y/n): N
• PMA/PMN Number: NA
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: health professional
• Type of Report: Initial,Followup
• Report Date: 03/31/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Catalogue Number: POSTD3
• Device Lot Number: 2402019
• Was Device Available for Evaluation?: Yes
• Initial Date Manufacturer Received: 10/06/2020
• Initial Date FDA Received: 11/06/2020
• Supplement Dates Manufacturer Received: 10/06/2020
• Supplement Dates FDA Received: 03/31/2021
• Patient Sequence Number: 1