MAUDE Adverse Event Report: DENTSPLY LLC CAVITRON G124 GENERATOR - CAVITRON SELECT SPS; SCALER, ULTRASONIC

Model Number G124

Device Problems Restricted Flow rate (1248); Component Missing (2306); Sparking (2595)

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

Event Type  malfunction  

Event Description

While the customer was using a g124 cavitron select sps, they allege that unit had no water flow and the unit sparked when it was plugged in to the power supply.No injury was reported from the alleged event.

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.

Manufacturer Narrative

Could not duplicate issue "no water flow".Power supply input pins contacting each other, causing sparks when unit is on and someone plugs in power supply.Refrain from plugging in power supply while unit knob is in on position.Turn off unit before plugging in power supply.

• Brand Name: CAVITRON G124 GENERATOR - CAVITRON SELECT SPS
• Type of Device: SCALER, ULTRASONIC
• Manufacturer (Section D): DENTSPLY LLC; 1301 smile way; york PA 17404
• Manufacturer (Section G): DENTSPLY LLC; 1301 smile way; york PA 17404
• Manufacturer Contact: hannah seevaratnam ; 221 w. philadelphia st.; york, PA 17401 ; 7178494593
• MDR Report Key: 15146673
• MDR Text Key: 304686837
• Report Number: 2424472-2022-00027
• Device Sequence Number: 1
• Product Code: ELC
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K970123
• 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: 09/12/2022

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 Model Number: G124
• Device Catalogue Number: 81324
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 08/01/2022
• Initial Date FDA Received: 08/02/2022
• Supplement Dates Manufacturer Received: 08/01/2022
• Supplement Dates FDA Received: 09/12/2022
• Was Device Evaluated by Manufacturer?: No
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1