BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CERTAIN® ZIREAL® POST 4.1(D) X 6(P) X 4(H) W/ZIREAL® HEXED SCREWS

    MDR report key: 3951114 · Received July 22, 2014

    Report

    Report Number
    0001038806-2014-00086
    Event Type
    Malfunction
    Date Received
    July 22, 2014
    Date of Event
    September 7, 2013
    Report Date
    October 1, 2013
    Manufacturer
    BIOMET 3I
    Product Code
    NHA
    PMA / PMN Number
    PD051973
    Removal / Correction Number
    N/A
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    DENTIST

    Narratives

    Additional Manufacturer Narrative · 1

    AT THE TIME BIOMET 3I BECAME AWARE OF THIS EVENT, IT WAS NOT CONSIDERED REPORTABLE. SUBSEQUENT REVIEW OF REPORTING POLICIES HAS DETERMINED ABUTMENT FRACTURES FOR THIS PRODUCT TYPE SHOULD BE REPORTED AS MALFUNCTIONS. THIS EVENT WAS IDENTIFIED AS ONE REQUIRING RETROSPECTIVE REPORTING BASED ON A RECENT AUDIT OF COMPLAINT DATA AND ENHANCEMENTS MADE TO REPORTING POLICIES APPLICABLE TO ABUTMENT FRACTURES. INVESTIGATION RESULTS: UPON VISUAL INSPECTION, IT WAS FOUND THAT THE ABUTMENT SEPARATED FROM THE CERAMIC. THERE WAS NO SCREW RETURNED. THEREFORE, THE ABUTMENT DOES NOT FUNCTION WITHIN REQUIRED MANUFACTURING SPECIFICATION. THE LOT AND ORDER NUMBER WERE NOT PROVIDED. THE PRODUCT'S COMPLAINT HISTORY DID NOT PROVIDE ANY INDICATION OF A MANUFACTURING DEVIATION THAT WOULD CAUSE THIS CONDITION.

    Description of Event or Problem · 1

    DOCTOR INDICATED THAT THE "PORC FRACTURED FROM METAL (ABUTMENT)." THERE WAS NO PATIENT INFECTION OR INJURY. ICAP464.

    Description of Event or Problem · 1

    DOCTOR INDICATED THAT THE "PORC FRACTURED FROM METAL (ABUTMENT)." THERE WAS NO PATIENT INFECTION OR INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    428360 CERTAIN® ZIREAL® POST 4.1(D) X 6(P) X 4(H) W/ZIREAL® HEXED SCREWS CERTAIN® ZIREAL® POST 4.1(D) X 6(P) X 4(H) W/ZIREAL® HEXED SCREWS NHA BIOMET 3I N/A N/A

    Patients

    Seq Age Sex Outcome Treatment
    1 60 YR