FDA Adverse Event Malfunction Summary report: N

CERTAIN® GOLD-TITE® HEXED SCREW

MDR report key: 15294252 · Received August 25, 2022

Report

Report Number
0001038806-2022-01315
Event Type
Malfunction
Date Received
August 25, 2022
Report Date
January 19, 2023
Manufacturer
BIOMET 3I
Product Code
NHA
PMA / PMN Number
K072642
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MA, US
Reporter Occupation
DENTIST
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

ZIMMERBIOMET COMPLAINT NUMBER (B)(4).

Additional Manufacturer Narrative · 0

ZIMMERBIOMET COMPLAINT NUMBER (B)(4). THE REPORTED DEVICE WAS NOT RETURNED FOR INVESTIGATION. SINCE PRODUCTS HAVE NOT BEEN RETURNED, VISUAL/FUNCTIONAL INSPECTION COULD NOT BE PERFORMED. NO PRE-EXISTING CONDITIONS WERE NOTED ON THE PRODUCT EXPERIENCE REPORT (PER). X-RAY OR PICTURE WAS NOT PROVIDED. A DEVICE HISTORY RECORD (DHR)REVIEW WAS PERFORMED AND NO RELATED DEVIATIONS OR NON-CONFORMANCES WERE NOTED. ALSO, A COMPLAINT HISTORY SEARCH WAS PERFORMED USING OUR COMPLAINT HANDLING SYSTEM AND THERE WERE NO RELATED COMPLAINTS FOR THIS PRODUCT LOT. A DEVICE HISTORY RECORD (DHR) REVIEW AND COMPLAINT HISTORY REVIEW COULD NOT BE PERFORMED, AS THE LOT NUMBERS ASSOCIATED WITH THE REPORTED PRODUCT ARE NOT AVAILABLE. HOWEVER, ZIMMER BIOMET QUALITY MANAGEMENT SYSTEM (QMS) HAS CONTROLS IN PLACE TO ENSURE THE DISTRIBUTION OF CONFORMING PRODUCT WITHIN SPECIFICATIONS. COMPLAINANT REPORTED THAT THE SCREW LOOSENED IN THE PATIENT'S MOUTH. THE REPORTED COMPLAINT COULD NOT BE VERIFIED. A DEFINITIVE ROOT CAUSE FOR THIS COMPLAINT COULD NOT BE DETERMINED.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE SCREW LOOSENED IN THE PATIENT'S MOUTH. THE SCREW WAS RETIGHTENED.

Description of Event or Problem · 0

NO FURTHER EVENT INFORMATION IS AVAILABLE AT THE TIME OF THIS REPORT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2375075 CERTAIN® GOLD-TITE® HEXED SCREW ABUTMENT SCREW NHA BIOMET 3I

Patients

Seq Age Sex Outcome Treatment
1 Unknown