BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SYBRONPRO TL

    MDR report key: 2092420 · Received May 18, 2011

    Report

    Report Number
    2016150-2011-00080
    Event Type
    Injury
    Date Received
    May 18, 2011
    Date of Event
    December 8, 2010
    Report Date
    April 18, 2011
    Manufacturer
    EBI INC.
    Product Code
    DZE
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    MD, US
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    ON (B)(6), 2011 A DOCTOR REPORTED THAT A PATIENT LOST A SYBRONPRO TL IMPLANT APPROXIMATELY SIX (6) MONTHS AFTER PLACEMENT AS A RESULT OF HAVING NO BUCCAL WALL DUE TO A PERIODONTAL DEFECT. THIS MDR IS THE SECOND OF TWO REPORTS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SYBRONPRO TL IMPLANT, ENDOSSEOUS, ROOT-FORM DZE EBI INC. 081096

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR Other| R