BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RESTORE 5X10 SELF-TAP+

    MDR report key: 149631 · Received February 19, 1998

    Report

    Report Number
    2184002-1998-00126
    Event Type
    Injury
    Date Received
    February 19, 1998
    Date of Event
    January 19, 1998
    Report Date
    February 19, 1998
    Manufacturer
    LIFECORE BIOMEDICAL, INC.
    Product Code
    DZE
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    IMPLANT FAILED AND WAS REMOVED 1/19/1998. ONE PERSON AFFECTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RESTORE 5X10 SELF-TAP+ Implant ENDOSSEOUS IMPLANT DZE LIFECORE BIOMEDICAL, INC. R9010-50-10 UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Required Intervention