BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BL, Ø 4.1MM RC, SLACTIVE 12MM, TIZR, NTP

    MDR report key: 8977454 · Received September 9, 2019

    Report

    Report Number
    0001222315-2019-01189
    Event Type
    Injury
    Date Received
    September 9, 2019
    Date of Event
    April 23, 2019
    Report Date
    September 9, 2019
    Manufacturer
    INSTITUT STRAUMANN AG
    Product Code
    DZE
    UDI-DI
    07630031706874
    PMA / PMN Number
    K121131
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TN, US
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    'FIED'. THE DEVICE WAS FORWARDED TO THE MANUFACTURER FOR INVESTIGATION. THERE WERE NO REPORTED PATIENT INJURIES OR COMPLICATIONS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    769259 BL, Ø 4.1MM RC, SLACTIVE 12MM, TIZR, NTP ENDOSSEOUS DENTAL IMPLANT DZE INSTITUT STRAUMANN AG RV396 07630031706874

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR Required Intervention