BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TYTIN

    MDR report key: 4178731 · Received October 16, 2014

    Report

    Report Number
    1815757-2014-00011
    Event Type
    Malfunction
    Date Received
    October 16, 2014
    Report Date
    October 2, 2014
    Manufacturer
    KERR CORPORATION
    Product Code
    DZS
    PMA / PMN Number
    K935535
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    DENTIST

    Narratives

    Additional Manufacturer Narrative · 1

    SPECIFIC INFORMATION WITH REGARD TO PATIENT AGE AND WEIGHT WAS NOT PROVIDED. IT WAS REPORTED THAT THE PATIENT HAD EXPERIENCED SENSITIVITY. UPON THE PATIENT'S RETURN VISIT, THE DOCTOR REMOVED THE AMALGAM AND REPEATED THE PROCEDURE, WITHOUT FURTHER INCIDENT. TO DATE, THE PATIENT IS DOING FINE. THE PRODUCT WAS NOT RETURNED AND NO LOT NUMBER WAS PROVIDED; THEREFORE, NO EVALUATION CAN BE CONDUCTED.

    Additional Manufacturer Narrative · 1

    THE PRODUCT WAS NOT RETURNED; THEREFORE, A VISUAL AND PHYSICAL EVALUATION WAS PERFORMED ON A RETAIN SAMPLE, YIELDING RESULTS WITHIN SPECIFICATION FOR THE CARVE TIME.

    Description of Event or Problem · 1

    A DOCTOR ALLEGED THAT THE TYTIN AMALGAM WAS SETTING UP TOO QUICKLY DURING PROCEDURES FOR MULTIPLE PATIENTS. THIS IS THE FIRST OF THREE (3) REPORTS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    659652 TYTIN DENTAL AMALGAM CAPSULE DZS KERR CORPORATION 3-1302

    Patients

    Seq Age Sex Outcome Treatment
    1 Other| R