BEUDAMED
    FDA Adverse Event Injury Summary report: N

    (17-0564) ANK C/X IMPL C11/D5.5/L11

    MDR report key: 11332382 · Received February 16, 2021

    Report

    Report Number
    9612468-2020-02073
    Event Type
    Injury
    Date Received
    February 16, 2021
    Date of Event
    November 24, 2020
    Report Date
    February 11, 2021
    Manufacturer
    DENTSPLY IMPLANTS (A DIVISION OF DENTSPLU IH AB)
    Product Code
    DZE
    PMA / PMN Number
    K140347
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    DENTIST

    Narratives

    Additional Manufacturer Narrative · 1

    THEREFORE, BECAUSE A SERIOUS INJURY RESULTED, THIS EVENT IS REPORTABLE PER 21 CFR PART 803. THE DEVICE WAS NOT EVALUATED BECAUSE THE ISSUE IS A KNOWN INHERENT RISK OF THE DEVICE. WE WILL CONTINUE TO TRACK AND MONITOR THE TREND.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT A PATIENT EXPERIENCED A DENTAL IMPLANT LOSS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    230025 (17-0564) ANK C/X IMPL C11/D5.5/L11 IMPLANT, ENDOSSEOUS, ROOT-FORM DZE DENTSPLY IMPLANTS (A DIVISION OF DENTSPLU IH AB) NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention