BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SYBRONPRO XRT

    MDR report key: 1740960 · Received June 29, 2010

    Report

    Report Number
    2016150-2010-00096
    Event Type
    Injury
    Date Received
    June 29, 2010
    Date of Event
    April 21, 2010
    Report Date
    June 22, 2010
    Manufacturer
    EBI INC.
    Product Code
    DZE
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    US
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    ON JUNE 22, 2010, A DOCTOR REPORTED THAT A PATIENT LOST A SYBRONPRO XRT IMPLANT SIX (6) MONTHS AFTER PLACEMENT DUE TO UNKNOWN CAUSES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SYBRONPRO XRT IMPLANT, ENDOSSEOUS, ROOT-FORM DZE EBI INC. 091110/093119

    Patients

    Seq Age Sex Outcome Treatment
    1 49 YR Other| R