BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SYBRONPRO XRT

    MDR report key: 2152059 · Received July 7, 2011

    Report

    Report Number
    2016150-2011-00141
    Event Type
    Injury
    Date Received
    July 7, 2011
    Date of Event
    June 20, 2011
    Report Date
    June 29, 2011
    Manufacturer
    EBI INC.
    Product Code
    DZE
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    CA
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    ON (B)(6) 2011, A DOCTOR REPORTED THAT A PATIENT LOST A SYBRONPRO XRT IMPLANT APPROXIMATELY TWO (2) MONTHS AFTER PLACEMENT DUE TO PERI-IMPLANTITIS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SYBRONPRO XRT IMPLANT, ENDOSSEOUS, ROOT-FORM DZE EBI INC. 081111

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Other| R