MAUDE Adverse Event Report: DENTSPLY LLC 30K CAV.THINSERT-FG,PACKED; SCALER, ULTRASONIC

Catalog Number	82009
Medical Device Problem Code	Overheating of Device (1437)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	11/15/2024
Type of Reportable Event	Malfunction
Event or Problem Description
In this event it is reported that 30k cav.Thinsert-fg, packed it is alleged that the device is getting very hot.No injury occurred.
Additional Manufacturer Narrative
While no serious injury resulted in this event, if this malfunction recurred, it could cause or contribute to a serious injury or require medical or surgical intervention to preclude such.This event; therefore, 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.
Additional Manufacturer Narrative
Return qty.1, 24110, 30k thinsert fg-66, 00117932 bul.30k.Test method / gp005-wi02.Inductance: gauge id# 5390, due: 12/31/2024, result 3.10.Meets spec? does not meet spec? n/a.Tip condition: ? meets spec ? does not meet spec ? n/a.Stack condition ? meets spec ? does not meet spec ? n/a.Tested on: g130 gage id# 9626-2.Due date: 03/31/25.Set pressure: 35 psi.Water flow: output rate: 35 psi - ? meets spec? does not meet spec ? n/a.Spray: ? meets spec ? does not meet spec ? n/a.Water leak: ? hp sealing ring ? proximal ring ? distal ring.Seam leak ? n/a.Vibration: - ? meets spec ? does not meet spec ? n/a.Grip condition: ? meets spec ? does not meet spec ? n/a.Other visual observation: insert tip has a bad spray pattern.Insert was tested on a digital thermometer i.D.#6116a.Due date:09/30/2025.The temperature was 88.4 °f, no fault found.The specifications state the temperature is not to exceed 118.4°f.(per frs-9175).Alleged event:? confirmed ? not confirmed.

• Brand Name: 30K CAV.THINSERT-FG,PACKED
• Common Device Name: 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 west philadelphia st.; york, PA 17401 ; 7178457511
• MDR Report Key: 20724013
• Report Number: 2424472-2024-00404
• Device Sequence Number: 6556001
• Product Code: ELC
• UDI-Device Identifier: D003820091
• UDI-Public: D003820091
• Combination Product (Y/N): N
• Initial Reporter State: MI
• Initial Reporter Country: US
• PMA/510(K) Number: K052334
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Dentist
• Type of Report: Initial,Followup
• Report Date (Section B): 02/10/2025

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: 82009
• Is the Reporter a Health Professional?: Yes
• Distributor Facility Aware Date: 11/15/2024
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 11/15/2024
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 11/19/2024
• Supplement Report FDA Received Date: 02/10/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Usage of Device: A
• Patient Sequence Number: 1
• Patient Sex: Unknown