BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RESTORE 3.75X13 SELF-TAPPING IMPLANT

    MDR report key: 186583 · Received September 11, 1998

    Report

    Report Number
    2184002-1998-00607
    Event Type
    Injury
    Date Received
    September 11, 1998
    Date of Event
    January 21, 1998
    Report Date
    August 14, 1998
    Manufacturer
    LIFECORE BIOMEDICAL, INC.
    Product Code
    DZE
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    IMPLANT PLACED 3/5/1997. IT FAILED DUE TO MOBILITY AND WAS REMOVED 1/21/1998. ONE PERSON AFFECTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RESTORE 3.75X13 SELF-TAPPING IMPLANT Implant ENDOSSEOUS IMPLANT DZE LIFECORE BIOMEDICAL, INC. R9005-38-13 75950077

    Patients

    Seq Age Sex Outcome Treatment
    1 34 YR Required Intervention