BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LANCE INTERNAL HEX. IMPLANT DIA.3.30 L11.50MM, NP

    MDR report key: 21442852 · Received February 23, 2025

    Report

    Report Number
    3004203816-2025-11138
    Event Type
    Injury
    Date Received
    February 23, 2025
    Date of Event
    November 12, 2023
    Report Date
    February 23, 2025
    Manufacturer
    MIS IMPLANTS TECHNOLOGIES LTD.
    Product Code
    DZE
    UDI-DI
    07290113995666
    PMA / PMN Number
    K192149
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CH
    Reporter Occupation
    003

    Narratives

    Additional Manufacturer Narrative · 0

    SINCE THIS EVENT RESULTED IN A SERIOUS INJURY, IT IS REPORTABLE PER 21 CFR PART 803. THE DEVICE WAS NOT EVALUATED BECAUSE THE ISSUE IS A KNOWN INHERENT RISK OF THE DEVICE. WE WILL CONTINUE TO TRACK AND MONITOR THE TREND. THIS MDR REPORT IS A LATE SUBMISSION. A CAPA (NCR2405716) HAS BEEN ISSUED.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT A PATIENT EXPERIENCED A DENTAL IMPLANT LOSS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    402026 LANCE INTERNAL HEX. IMPLANT DIA.3.30 L11.50MM, NP IMPLANT, ENDOSSEOUS, ROOT-FORM DZE MIS IMPLANTS TECHNOLOGIES LTD. N/A W 07290113995666

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Unknown Required Intervention