BEUDAMED
    FDA Adverse Event Other Summary report: N

    O BUTMENT

    MDR report key: 59646 · Received December 26, 1996

    Report

    Report Number
    1627417-1996-90003
    Event Type
    Other
    Date Received
    December 26, 1996
    Date of Event
    September 24, 1996
    Report Date
    December 18, 1996
    Manufacturer
    "O" CO, 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 BY DR, YET RESTORED BY ANOTHER DENTIST. CROWN WAS PLACED AND BROKE OFF IN IMPLANT. AFTER REMOVING BROKEN CROWN, DR ACCIENTALLY STRIPPED HE THREADS OF THE IMPLANT. IMPLANT WAS REMOVED AND REPLACED BY ANOTHER IMPLANT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 O BUTMENT Implant DENTAL IMPLANT DZE "O" CO, INC. * *

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR Other