BEUDAMED
    FDA Adverse Event Other Summary report: N

    IMPLANTIUM

    MDR report key: 1003090 · Received February 22, 2008

    Report

    Report Number
    3004578807-2008-00050
    Event Type
    Other
    Date Received
    February 22, 2008
    Date of Event
    November 12, 2007
    Report Date
    November 16, 2007
    Manufacturer
    DENTIUM CO., LTD.
    Product Code
    DZE
    PMA / PMN Number
    K041368
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KS
    Reporter Occupation
    DENTIST

    Narratives

    Additional Manufacturer Narrative · 1

    ACCORDING TO OUR INVESTIGATION, THERE WAS NO DISCREPANCY ON OUR PRODUCT. THERE IS NO INFO ABOUT MEDICAL CONDITION OF PT. SEE SCANNED PAGES.

    Description of Event or Problem · 1

    THE IMPLANT WAS PLACED AT # 25 AND REMOVED AFTER 6 MOS. TRADITIONAL 2 STAGE SURGERY. FIXTURE WAS PLACED WITH PRIMARY CLOSURE. PROSTHETIC ATTACHMENT (SINGLE). SINUS ELEVATION SURGERY WAS PERFORMED WITH AUTOGENOUS BONE GRAFT. GOOD ORAL HYGIENE. GOOD BONE CONDITION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IMPLANTIUM ENDOSSEOUS DENTAL IMPLANT DZE DENTIUM CO., LTD. MF4810 07A06-R

    Patients

    Seq Age Sex Outcome Treatment
    1 33 YR Required Intervention