BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SST 4X13 HA CYLINDER

    MDR report key: 35929 · Received August 26, 1996

    Report

    Report Number
    2184002-1996-00155
    Event Type
    Injury
    Date Received
    August 26, 1996
    Date of Event
    February 29, 1996
    Report Date
    August 26, 1996
    Manufacturer
    LIFECORE BIOMEDICAL, INC.
    Product Code
    DZE
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    IMPLANT WAS PLACED ON 12/3/92. BRIDGE CAME OFF AND IMPLANT WITH IT, AFTER SEVERAL ATTEMPTS TO SAVE IT. THE MAXILLARY IMPLANTS, #13 AND #14, HAVE NOT BEEN UNCOVERED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SST 4X13 HA CYLINDER Implant ENDOSSEOUS IMPLANT DZE LIFECORE BIOMEDICAL, INC. 411020-40-13 UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR Required Intervention