BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SYBRONPRO TL

    MDR report key: 1664280 · Received April 21, 2010

    Report

    Report Number
    2016150-2010-00055
    Event Type
    Injury
    Date Received
    April 21, 2010
    Date of Event
    February 23, 2010
    Report Date
    March 22, 2010
    Manufacturer
    EBI INC.
    Product Code
    DZE
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    SC, US
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    ON MARCH 22, 2010, A DOCTOR REPORTED THAT A PATIENT LOST A DENTAL IMPLANT SEVEN MONTHS AFTER PLACEMENT DUE UNKNOWN REASONS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SYBRONPRO TL IMPLANT, ENDOSSEOUS, ROOT-FORM DZE EBI INC. 081073

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR Other| R