BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BLT Ø4.1MM RC, SLACTIVE® 12MM, TIZR, NTP

    MDR report key: 18419883 · Received December 29, 2023

    Report

    Report Number
    0001222315-2023-032115
    Event Type
    Injury
    Date Received
    December 29, 2023
    Date of Event
    October 27, 2023
    Report Date
    December 29, 2023
    Manufacturer
    INSTITUT STRAUMANN AG
    Product Code
    DZE
    UDI-DI
    07630031707048
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    VA, US
    Reporter Occupation
    DENTIST
    Health Professional
    Yes

    Narratives

    Description of Event or Problem · 0

    THE CLINICIAN REPORTS THE IMPLANT WAS INSERTED (B)(6) 2023 IN ADA 13. ON 2023-10-27, NON-OSSEOINTEGRATION WAS VERIFIED. THE DEVICE WAS FORWARDED TO THE MANUFACTURER. THERE WERE NO REPORTED PATIENT INJURIES OR COMPLICATIONS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2285496 BLT Ø4.1MM RC, SLACTIVE® 12MM, TIZR, NTP ENDOSSEOUS DENTAL IMPLANT DZE INSTITUT STRAUMANN AG WHH64 07630031707048

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR Female Required Intervention