BEUDAMED
    FDA Adverse Event Injury Summary report: N

    IMPLANTIUM

    MDR report key: 1150538 · Received September 3, 2008

    Report

    Report Number
    3004578807-2008-00250
    Event Type
    Injury
    Date Received
    September 3, 2008
    Date of Event
    August 4, 2008
    Report Date
    August 7, 2008
    Manufacturer
    DENTIUM
    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 WITH OUR PRODUCT.

    Description of Event or Problem · 1

    THE IMPLANT FAILED DUE TO PATIENT BONE CONDITION. THE IMPLANT WAS PLACED AT TOOTH #1. POOR ORAL HYGIENE. TRADITIONAL 2 STAGE. BONE GRAFTING MATERIAL USED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IMPLANTIUM ENDOSSEOUS DENTAL IMPLANT DZE DENTIUM MF FX4310 07J30-R

    Patients

    Seq Age Sex Outcome Treatment
    1 34 YR Required Intervention