BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SYBRONPRO XRT

    MDR report key: 1935795 · Received December 22, 2010

    Report

    Report Number
    2016150-2010-00216
    Event Type
    Injury
    Date Received
    December 22, 2010
    Date of Event
    September 18, 2010
    Report Date
    December 2, 2010
    Manufacturer
    EBI INC.
    Product Code
    DZE
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    IN, US
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    ON (B)(6) 2010 A DOCTOR REPORTED THAT A PATIENT LOST A SYBRONPRO XRT IMPLANT ONE (1) MONTH AFTER PLACEMENT DUE TO UNKNOWN CAUSES. THIS IS THE FIRST OF TWO REPORTS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SYBRONPRO XRT IMPLANT, ENDOSSEOUS, ROOT-FORM DZE EBI INC. 091163

    Patients

    Seq Age Sex Outcome Treatment
    1 49 YR Other| R