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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: TULSA DENTAL PRODUCTS LLC X-SMART CONTRA ANGLE 16:1; HANDPIECE, DIRECT DRIVE, AC-POWERED
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TULSA DENTAL PRODUCTS LLC X-SMART CONTRA ANGLE 16:1; HANDPIECE, DIRECT DRIVE, AC-POWERED Back to Search Results
Catalog Number XSMARTCA
Device Problems Detachment of Device or Device Component (2907); Therapeutic or Diagnostic Output Failure (3023)
Patient Problems No Consequences Or Impact To Patient (2199); No Clinical Signs, Symptoms or Conditions (4582)
Event Date 04/13/2020
Event Type  malfunction  
Manufacturer Narrative
There has been a previous report received with a similar device 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.The covid-19 pandemic caused a disruption in normal business activities, resulting in late submission of this report.
 
Event Description
It was reported that an x-smart contra angle wouldn't hold files; no injury resulted.
 
Manufacturer Narrative
Multiple unsuccessful attempts were made to obtain the device for evaluation.
 
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Brand Name
X-SMART CONTRA ANGLE 16:1
Type of Device
HANDPIECE, DIRECT DRIVE, AC-POWERED
Manufacturer (Section D)
TULSA DENTAL PRODUCTS LLC
608 rolling hills drive
johnson city TN 37604
MDR Report Key10613678
MDR Text Key210015877
Report Number2320721-2020-00069
Device Sequence Number1
Product Code EKX
Combination Product (y/n)N
PMA/PMN Number
K990682
Number of Events Reported1
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
Date FDA Received10/01/2020
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Catalogue NumberXSMARTCA
Was Device Available for Evaluation? Yes
Date Manufacturer Received04/13/2020
Is This a Reprocessed and Reused Single-Use Device? No
Patient Sequence Number1
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