BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LEGACY 3 IMPLANT

    MDR report key: 11783080 · Received May 6, 2021

    Report

    Report Number
    3001617766-2021-02435
    Event Type
    Injury
    Date Received
    May 6, 2021
    Date of Event
    April 19, 2021
    Report Date
    May 6, 2021
    Manufacturer
    IMPLANT DIRECT SYBRON MANUFACTURING LLC
    Product Code
    DZE
    UDI-DI
    10841307102236
    PMA / PMN Number
    K090234
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KY, US
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    PER COMPLAINT (B)(4), PATIENT EXPERIENCED LOSS OF IMPLANT TO OSSEOINTEGRATE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    683943 LEGACY 3 IMPLANT DENTAL IMPLANT DZE IMPLANT DIRECT SYBRON MANUFACTURING LLC NA 165422 10841307102236

    Patients

    Seq Age Sex Outcome Treatment
    1 49 YR Required Intervention