MAUDE Adverse Event Report: DENTSPLY LLC REPAIR -CAV.JET PLUS TAP-ON; SCALER, ULTRASONIC

Catalog Number G137

Device Problems Restricted Flow rate (1248); Mechanical Problem (1384); Infusion or Flow Problem (2964)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Type  malfunction  

Manufacturer Narrative

There has been a previous report received where lack of water flow has caused an overheating insert.Since an overheating insert 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.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

While the customer was using a g137 scaler, they allege that they had no water or vibration.No injury was reported from the alleged event.

Manufacturer Narrative

Worn battery door, damaged water flow control on the handpiece cable.Debris buildup in the water filter.

• Brand Name: REPAIR -CAV.JET PLUS TAP-ON
• Type of Device: SCALER, ULTRASONIC
• Manufacturer (Section D): DENTSPLY LLC; 1301 smile way; york PA 17404
• MDR Report Key: 12532622
• MDR Text Key: 274302703
• Report Number: 2424472-2021-00059
• Device Sequence Number: 1
• Product Code: ELC
• Combination Product (y/n): N
• PMA/PMN Number: K052334
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: health professional
• Type of Report: Initial,Followup
• Report Date: 11/03/2021

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: G137
• Device Lot Number: G137-16498
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/10/2021
• Initial Date Manufacturer Received: 08/31/2021
• Initial Date FDA Received: 09/27/2021
• Supplement Dates Manufacturer Received: 08/31/2021
• Supplement Dates FDA Received: 11/03/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1