BEUDAMED
    FDA Adverse Event Death Summary report: N

    ABUTMENT:SHLD,2MM,OMNILOC,4.0

    MDR report key: 39079 · Received September 23, 1996

    Report

    Report Number
    2023141-1996-00061
    Event Type
    Death
    Date Received
    September 23, 1996
    Date of Event
    August 19, 1996
    Report Date
    August 26, 1996
    Manufacturer
    CALCITEK
    Product Code
    DZE
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    VA, US
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    AN ABUTMENT BROKE IN FUNCTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ABUTMENT:SHLD,2MM,OMNILOC,4.0 Implant SCREW RETAINED DENTAL ABUTMENT DZE CALCITEK NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Required Intervention