MAUDE Adverse Event Report: DENTSPLY LLC 30K FSI-SLI-FG-1000 INS,PKD; SCALER, ULTRASONIC

Catalog Number 82008

Device Problems Restricted Flow rate (1248); No Flow (2991); Temperature Problem (3022)

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

Event Date 10/11/2022

Event Type  malfunction  

Manufacturer Narrative

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 has not been returned as of this report.Evaluation results will be submitted as they become available.

Event Description

In this event it is reported that 30k fsi-sli-fg-1000 ins,pkd does not allow water to flow through and got very hot.No injury was reported from alleged event.

Manufacturer Narrative

Investigation results: did not receive insert.- device not returned.Dhr was reviewed on this complaint and everything meet specification.No product deviation.

• Brand Name: 30K FSI-SLI-FG-1000 INS,PKD
• 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 west philadelphia st.; york, PA 17401 ; 7178457511
• MDR Report Key: 15597519
• MDR Text Key: 306998068
• Report Number: 2424472-2022-00322
• Device Sequence Number: 1
• Product Code: ELC
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K052334/K970
• 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: 01/11/2023

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 Catalogue Number: 82008
• Device Lot Number: 16D 202209123 2
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Distributor Facility Aware Date: 10/12/2022
• Initial Date Manufacturer Received: 10/12/2022
• Initial Date FDA Received: 10/13/2022
• Supplement Dates Manufacturer Received: 10/12/2022
• Supplement Dates FDA Received: 01/11/2023
• Was Device Evaluated by Manufacturer?: No
• Type of Device Usage: A
• Patient Sequence Number: 1