FDA Adverse Event Injury Summary report: N

APC PLUS ADHESIVE

MDR report key: 863219 · Received June 7, 2007

Report

Report Number
2020467-2007-00002
Event Type
Injury
Date Received
June 7, 2007
Date of Event
February 28, 2007
Report Date
May 14, 2007
Manufacturer
3M UNITEK
Product Code
DYW
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
LU
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

CATALOG #: 5017-519, 5017-661, 5017-662, 5017-669, 5017-670, 5017-675, 5017-676, 5017-679, 5017-680, 5017-683, 5017-686, 5017-689, 6800-751, 6800-572, 6800-753, 6800-754, 6800-755, 6800-756, 6800-757, 6800-758, 6800-761,6800-762, 6800-774, 6800-775, 6800-776, 6800-924.

Description of Event or Problem · 1

AFTER STARTING ORTHODONTIC TREATMENT, PT DEVELOPED A REACTION, WHICH CONSISTED OF ITCHING ON THE HEAD AND NECK. SUBSEQUENT TESTS SHOWED THAT THE PT IS ALLERGIC TO METHACRYLATES, GOLD, AND MERCURY. PT WEAR GOLD JEWELRY AND HAS AMALGAM RESTORATIONS IN HER TEETH. THE APC PLUS ADHESIVE PRECOATED ORTHODONTIC BRACKETS USED IN THE PT'S ORTHODONTIC TREATMENT CONTAIN METHACRYLATES. PT WAS GIVEN ANTIHISTAMINES TO CONTROL THE ITCHING AND CONTINUES HER ORTHODONTIC TREATMENT (THE ORTHODONTIC BRACKETS HAVE NOT BEEN REMOVED FROM THE PT'S MOUTH). INSTRUCTION -FOR USE FOR APC PLUS ADHESIVE COATED ORTHODONTIC BRACKETS CONTAINS THE FOLLOWING WARNING: ACRYLATE MONOMERS ARE KNOWN TO PRODUCE ALLERGIC SKIN REACTIONS IN CERTAIN SENSITIVE INDIVIDUALS. MAY CAUSE EYE AND SKIN IRRITATION. PRECAUTIONS: AVOID EYE AND SKIN CONTACT. WEAR GLOVES WHEN HANDLING THIS MATERIAL. FIRST AID: EYE CONTACT: IMMEDIATELY FLUSH WITH PLENTY OF WATER. SEE A PHYSICIAN IF IRRITATION PERSISTS. SKIN CONTACT: WASH AFFECTED AREA WITH SOAP AND WATER. SEE A PHYSICIAN IF IRRITATION PERSISTS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 APC PLUS ADHESIVE ORTHODONTIC ADHESIVE DYW 3M UNITEK NA UNK

Patients

Seq Age Sex Outcome Treatment
1 YR Required Intervention ARCHWIRES| ORTHODONTIC METAL AND CERAMIC BRACKETS