BEUDAMED
    FDA Adverse Event Other Summary report: N

    MICROLOK IMPLANT

    MDR report key: 509336 · Received January 14, 2004

    Report

    Report Number
    1045056-2003-00061
    Event Type
    Other
    Date Received
    January 14, 2004
    Date of Event
    December 12, 2003
    Manufacturer
    BIOLOK INTERNATIONAL INC.
    Product Code
    DZE
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    IMPLANT LOOSE UNDER IMMEDIATE COMPLETE DENTURE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MICROLOK IMPLANT ENDOSSEOUS DZE BIOLOK INTERNATIONAL INC. IITSS513D 3946A

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other