MAUDE Adverse Event Report: BIOMET 3I CERTAIN® 4, 5, 6MM(D) IMPLANT DRIVER TIP - LONG; DENTAL DRIVER

Model Number	IIPDTL
Medical Device Problem Code	Separation Failure (2547)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	06/04/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Zimmer biomet complaint number (b)(4).
Event or Problem Description
The doctor reports that the implant has not been placed because the driver does not disengage.The affected dental position is unknown.The doctor confirms that the procedure was completed with another tool and that the patient did not suffer any impact on his health.
Additional Manufacturer Narrative
Zimmerbiomet complaint number (b)(4).One certain® 4, 5, 6mm(d) implant driver tip - long (iipdtl) was returned for investigation.Visual inspection of the as returned product identified signs of wear from use.Functional testing of the components note that both could not be disengaged.No pre-existing conditions were noted on the per.The reported implant was located on an unknown tooth site and was removed the same day.Device history record (dhr) review was completed for the subject lot number.It was confirmed that all operations and inspections were executed as per applicable procedure.No deviations or non-conformances, which could have caused or contributed to the reported event was noted as part of the dhr.Lot was inspected and passed all acceptance criteria by qa.Complaint history review was performed for the reported lot numbers (1184090) for similar event and 1 other complaint was identified utilizing keyword(s) 'does not disengage'.September post market trending was reviewed and there were no actionable events or corrective actions for the reported event(s) (stuck components) or product (bost485).Therefore, based on the available information, device malfunction has occurred and the reported event was confirmed.
Event or Problem Description
No further event information is available at the time of this report.

• Brand Name: CERTAIN® 4, 5, 6MM(D) IMPLANT DRIVER TIP - LONG
• Common Device Name: DENTAL DRIVER
• Manufacturer (Section D): BIOMET 3I; 4555 riverside drive; palm beach gardens FL 33410
• Manufacturer (Section G): BIOMET 3I; 4555 riverside drive; palm beach gardens FL 33410
• Manufacturer Contact: susanne taylor ; 4555 riverside drive; palm beach gardens, FL 33410 ; 5617766700
• MDR Report Key: 12311560
• Report Number: 0001038806-2021-01485
• Device Sequence Number: 19867801
• Product Code: NDP
• UDI-Device Identifier: 00844868005995
• UDI-Public: (01)00844868005995(10)1184090
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional
• Initial Reporter Occupation: Dentist
• Type of Report: Initial,Followup
• Report Date (Section B): 12/02/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Model Number: IIPDTL
• Device Catalogue Number: IIPDTL
• Device Lot Number: 1184090
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/19/2021
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 07/19/2021
• Supplement Date Received by Manufacturer: 11/18/2021
• Initial Report FDA Received Date: 08/12/2021
• Supplement Report FDA Received Date: 12/02/2021
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 09/16/2016
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Patient Sex: Female