BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ANK IMPL A9,5 D3,5 MM/L9,5 MM

    MDR report key: 16139778 · Received January 11, 2023

    Report

    Report Number
    3013111692-2023-29700
    Event Type
    Injury
    Date Received
    January 11, 2023
    Date of Event
    November 17, 2022
    Report Date
    January 16, 2023
    Manufacturer
    DENTSPLY IMPLANTS MANUFACTURING GMBH
    Product Code
    DZE
    PMA / PMN Number
    K041509
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AU
    Reporter Occupation
    DENTIST
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    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.

    Additional Manufacturer Narrative · 0

    DEVICE RECEIVED FOR THIS EVENT IS BEING CORRECTED FROM ANK IMPL A9,5 D3,5 MM/L9,5 MM CATALOG # 17-0143 TO ANK IMPL A9,5 D3,5 MM/L9,5 MM CATALOG # 31010208. CORRECTING LOT # FROM LOT # 20051019 TO LOT # 20050708.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT A PATIENT EXPERIENCED A DENTAL IMPLANT LOSS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1118003 ANK IMPL A9,5 D3,5 MM/L9,5 MM IMPLANT, ENDOSSEOUS, ROOT-FORM DZE DENTSPLY IMPLANTS MANUFACTURING GMBH 20050708

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown Required Intervention