FDA Adverse Event Injury Summary report: N

IMPL TAPERED SCR-V MTX 3.7MM 3.5MM 11.5MM

MDR report key: 20705782 · Received November 18, 2024

Report

Report Number: 0002023141-2024-03718
Event Type: Injury
Date Received: November 18, 2024
Date of Event: May 27, 2024
Report Date: November 17, 2024
Manufacturer: ZIMMER DENTAL
Product Code: DZE
UDI-DI: 00889024019515
PMA / PMN Number: K061410
Adverse Event: Yes
Report Source: Manufacturer report
Reporter Location: FR
Reporter Occupation: DENTIST
Health Professional: Yes

Narratives

Additional Manufacturer Narrative · 0

ZIMVIE COMPLAINT NUMBER: (B)(4). G4: PREMARKET IDENTIFICATION K061410/K013227. H6: PATIENT CODE 1994 PAIN. 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-CONFORMANCE'S 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. H3 OTHER TEXT: SUMMARY INVESTIGATION.

Description of Event or Problem · 0

ON CHECK-UP, THE PATIENT COMPLAINED OF PAIN. MOBILE IMPLANT, SO WAS REMOVED DUE TO PERI IMPLANTITIS. SYMPTOM: INFLAMMATION. TOOTH SITE 14.

Devices

Seq	Brand	Generic	Product Code	Manufacturer	Model	Lot	UDI-DI
2595159	IMPL TAPERED SCR-V MTX 3.7MM 3.5MM 11.5MM	DENTAL IMPLANT	DZE	ZIMMER DENTAL		63749188	00889024019515

Patients

Seq	Age	Sex	Outcome	Treatment
1	86 YR	Male