BEUDAMED
    FDA Adverse Event Injury Summary report: N

    IMPLANTIUM

    MDR report key: 1210248 · Received October 22, 2008

    Report

    Report Number
    3004578807-2008-00272
    Event Type
    Injury
    Date Received
    October 22, 2008
    Report Date
    September 24, 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 ON OUR PRODUCT. WE VISITED THE DENTIST ON THE 17TH OF SEPTEMBER, BUT WERE UNABLE TO OBTAIN ADDITIONAL INFO. CONCLUSION: BASED ON OUR INSPECTION AND TEST RESULTS, THE RETURNED PRODUCT HAS BEEN FOUND TO BE WITHIN SPECIFICATIONS. THEREFORE, THE IMPLANT FAILURE IS MOST LIKELY DUE TO CAUSES OTHER THAN THE PRODUCT SUCH AS SURGICAL MISTAKE, PT BONE CONDITION, PT ORAL HYGIENE, OR PT BEHAVIOR. SEE SCANNED PAGES.

    Description of Event or Problem · 1

    TRADITIONAL 2 STAGE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IMPLANTIUM ENDOSSEOUS DENTAL IMPLANT DZE DENTIUM MF FX3810

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention