FDA Adverse Event Injury Summary report: N

IMPL TAPERED SCR-V SBM 3.7MM 3.5MM 10MM

MDR report key: 19366712 · Received May 21, 2024

Report

Report Number: 0002023141-2024-01686
Event Type: Injury
Date Received: May 21, 2024
Date of Event: October 25, 2022
Report Date: May 20, 2024
Manufacturer: ZIMMER DENTAL
Product Code: DZE
UDI-DI: 00889024019508
PMA / PMN Number: K061410
Adverse Event: Yes
Report Source: Manufacturer report
Reporter Location: GM
Reporter Occupation: DENTIST
Health Professional: Yes

Narratives

Additional Manufacturer Narrative · 0

ZIMVIE COMPLAINT NUMBER (B)(4) PATIENT WEIGHT UNKNOWN / NOT PROVIDED. PREMARKET IDENTIFICATION K061410/K011028/K013227. A SUMMARY INVESTIGATION HAS BEEN COMPLETED FOR PERI-IMPLANTITIS EVENTS RECOGNIZING THAT A DEFINITIVE ROOT CAUSE CANNOT BE IDENTIFIED DUE TO A WIDE RANGE OF EXTERNAL FACTORS (NON-DESIGN OR MANUFACTURING RELATED), INCLUDING MEDICAL CONDITIONS (E.G., DIABETES, POOR BONE QUALITY, ETC.) / PATIENT HABITS (E.G., SMOKING) AND SURGICAL TECHNIQUE. PREVIOUSLY COMPLETED INVESTIGATIONS FOR THESE EVENTS HAVE NOT IDENTIFIED ANY SIGNALS INDICATING POTENTIAL NON-CONFORMANCES AFFECTING THE MANUFACTURING AND STERILIZATION PROCESSES. FURTHERMORE, THE PROBABILITY OF A MANUFACTURING OR DESIGN DEFECT THAT MIGHT LEAD TO PERI-IMPLANTITIS OCCURRING AND ESCAPING THE AVAILABLE DETECTIONS HAS BEEN ASSESSED AND FOUND REMOTE AND ALMOST NONEXISTENT. SHOULD ADDITIONAL INFORMATION BE RECEIVED WHICH INDICATES THAT THE DEVICE MAY HAVE CAUSED OR CONTRIBUTED TO THE EVENT, AN ADDITIONAL REPORT WILL BE SUBMITTED.

Description of Event or Problem · 0

DOCTOR REPORTED THAT IMPLANTS AT TOOTH SITES 11, 12 WERE REMOVED DUE TO PERI-IMPLANTITIS.

Devices

Seq	Brand	Generic	Product Code	Manufacturer	Model	Lot	UDI-DI
583230	IMPL TAPERED SCR-V SBM 3.7MM 3.5MM 10MM	DENTAL IMPLANT	DZE	ZIMMER DENTAL		63764306	00889024019508

Patients

Seq	Age	Sex	Outcome	Treatment
1	59 YR	Female