BEUDAMED
    FDA Adverse Event Injury Summary report: N

    XIVE S PLUS IMPL D4.5/L8

    MDR report key: 11852943 · Received May 19, 2021

    Report

    Report Number
    9612468-2021-26921
    Event Type
    Injury
    Date Received
    May 19, 2021
    Date of Event
    February 10, 2021
    Report Date
    May 19, 2021
    Manufacturer
    DENTSPLY IMPLANTS (A DIVISION OF DENTSPLY IH AB)
    Product Code
    DZE
    PMA / PMN Number
    K073075
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FR
    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
    744160 XIVE S PLUS IMPL D4.5/L8 IMPLANT, ENDOSSEOUS, ROOT-FORM DZE DENTSPLY IMPLANTS (A DIVISION OF DENTSPLY IH AB) NA B120001077

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention