BEUDAMED
    FDA Adverse Event Injury Summary report: N

    C1-11330

    MDR report key: 23320152 · Received October 17, 2025

    Report

    Report Number
    3004203816-2025-39675
    Event Type
    Injury
    Date Received
    October 17, 2025
    Report Date
    October 16, 2025
    Manufacturer
    MIS IMPLANTS TECHNOLOGIES LTD.
    Product Code
    DZE
    UDI-DI
    07290108992137
    PMA / PMN Number
    K172505
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    VM
    Reporter Occupation
    003

    Narratives

    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
    2471211 C1-11330 IMPLANT, ENDOSSEOUS, ROOT-FORM DZE MIS IMPLANTS TECHNOLOGIES LTD. W23007472 07290108992137

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Male Required Intervention