MAUDE Adverse Event Report: DENTSPLY LLC CAVITRON JET PLUS W/TAPON-115V G137(DNA); SCALER, ULTRASONIC

Catalog Number 8187501

Device Problem Overheating of Device (1437)

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

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

While the customer was using a cavitron jet plus g137 they allege that the water, handpiece and insert tip gets hot.No injury was reported from the alleged event.

Manufacturer Narrative

05/07/24 cn.Hpc# 12210 sterimate# 202112-0 a2e reg, needle valve, hp flow control clogged no powder flow due to a blockade in the hp.Deteriorated nozzle grip.Debris build up in the water filter.Dead/low batteries in wireless foot pedal.Cleaned up the blockade, tested and recalibrated to manufacturing specifications.Qa by jb.

• Brand Name: CAVITRON JET PLUS W/TAPON-115V G137(DNA)
• 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: dan eagar ; 221 w. philadelphia st.; york, PA 17401 ; 7178494593
• MDR Report Key: 19195930
• MDR Text Key: 341196051
• Report Number: 2424472-2024-00033
• Device Sequence Number: 1
• Product Code: ELC
• UDI-Device Identifier: D00381875011
• UDI-Public: D00381875011
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K052334
• 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: 05/08/2024

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: 8187501
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 04/24/2024
• Initial Date FDA Received: 04/26/2024
• Supplement Dates Manufacturer Received: Not provided
• Supplement Dates FDA Received: 05/08/2024
• 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