FDA Adverse Event Injury Summary report: N

SSIII SA IMPLANT

MDR report key: 17856088 · Received October 2, 2023

Report

Report Number
3003394081-2023-00003
Event Type
Injury
Date Received
October 2, 2023
Report Date
April 6, 2023
Manufacturer
OSSTEM IMPLANT CO., LTD.
Product Code
DZE
PMA / PMN Number
K163557
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
US
Reporter Occupation
DENTIST
Health Professional
Yes

Narratives

Description of Event or Problem · 0

DENTAL IMPLANT FRACTURE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1099902 SSIII SA IMPLANT DENTAL IMPLANT DZE OSSTEM IMPLANT CO., LTD. ASS3W4510S

Patients

Seq Age Sex Outcome Treatment
1 Unknown Required Intervention