BEUDAMED
    FDA Adverse Event Injury Summary report: N

    IMPLANT OKTAGON 4.1X10MM

    MDR report key: 11918994 · Received June 2, 2021

    Report

    Report Number
    8010516-2021-00036
    Event Type
    Injury
    Date Received
    June 2, 2021
    Date of Event
    January 19, 2021
    Report Date
    June 2, 2021
    Manufacturer
    HAGER & MEISINGER GMBH
    Product Code
    DZE
    PMA / PMN Number
    K122807
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SW
    Reporter Occupation
    DENTIST

    Narratives

    Additional Manufacturer Narrative · 1

    THE INVESTIGATION OF THE COMPLAINT WAS CARRIED OUT CONSIDERING THE ANALYSIS OF THE INFORMATION GIVEN BY THE DENTIST IN THE GUARANTEE FORM, VISUAL CONFERENCE OF THE PRODUCT RETURNED BY THE DENTIST AND THE EVALUATION OF RELEVANT PRODUCTION RECORDS.

    Description of Event or Problem · 1

    OSSEOINTEGRATION WAS NOT ACHIEVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    817373 IMPLANT OKTAGON 4.1X10MM DENTAL IMPLANT DZE HAGER & MEISINGER GMBH 3631152DU0ACE B78246

    Patients

    Seq Age Sex Outcome Treatment
    1 50 YR Other