MAUDE Adverse Event Report: BIOMET 3I OSSEOTITE IMPLANT 5 X 10MM; DENTAL IMPLANT

Model Number	OSS510
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Unspecified Infection (1930); Pain (1994); No Code Available (3191)
Date of Event	03/02/2020
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Summary investigation (b)(4).Dob unknown.Weight unknown.A summary investigation has been completed for peri-implantitis events recognizing that a definitive root cause cannot be identified due to a wide range of external factors (non-design or manufacturing related), including medical conditions (e.G., diabetes, poor bone quality, etc.) / patient habits (e.G., smoking) and surgical technique.Previously completed investigations for these events have not identified any signals indicating potential non-conformances affecting the manufacturing and sterilization processes.Furthermore, the probability of a manufacturing or design defect that might lead to peri-implantitis occurring and escaping the available detections has been assessed and found remote and almost nonexistent.Should additional information be received which indicates that the device may have caused or contributed to the event, an additional report will be submitted.
Event or Problem Description
It was reported that the implant was removed due to peri-implantitis.
Event or Problem Description
Additional details of the reported event include patient reported pain and presented to the dental office with one implant (oss510) in hand.Doctor reported periimplantitis at tooth location 24.Patient has 4-implant supported lower complete denture.The additional 3 implants remains implanted.
Event or Problem Description
Udi number has been corrected.See h10.
Additional Manufacturer Narrative
Upon evaluation of the reported event, it was determined that device lot was manufactured prior to udi number requirements.Therefore, udi number is not applicable.The following section has been corrected: d4: unique identifier (udi) number: not applicable.

• Brand Name: OSSEOTITE IMPLANT 5 X 10MM
• Common Device Name: DENTAL IMPLANT
• Manufacturer (Section D): BIOMET 3I; 4555 riverside drive; palm beach gardens FL 33410
• MDR Report Key: 10213492
• Report Number: 0001038806-2020-00904
• Device Sequence Number: 2565236
• Product Code: DZE
• UDI-Device Identifier: 00844868013259
• UDI-Public: (01)00844868013259(17)061218(10)145089(241)OSS510
• Combination Product (Y/N): N
• Initial Reporter State: MA
• Initial Reporter Country: US
• PMA/510(K) Number: K063286
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2002
• Device Explanted Year: 2020
• Reporter Type: Manufacturer
• Report Source: health professional
• Initial Reporter Occupation: Dentist
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 08/10/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Lay User/Patient
• Device Expiration Date: 12/18/2006
• Device Model Number: OSS510
• Device Catalogue Number: OSS510
• Device Lot Number: 145089
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 06/11/2020
• Was the Report Sent to FDA?: No
• Initial Date Received by Manufacturer: 06/11/2020
• Supplement Date Received by Manufacturer: 06/11/2020; 08/03/2020
• Initial Report FDA Received Date: 06/30/2020
• Supplement Report FDA Received Date: 06/30/2020; 08/10/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 82 YR