MAUDE Adverse Event Report: ZIMMER DENTAL HEAL COLLAR 5.7X6.5, 5MM; HEALING COLLAR

Model Number	HC565
Medical Device Problem Code	Positioning Failure (1158)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Zimmer biomet complaint number (b)(4).Patient weight unknown / not provided.Date of event unknown / not provided.
Event or Problem Description
It was reported that the healing collar would not seat in patient's mouth at tooth # 14.The implant was buried.As a result of this event, no injuries to patient reported.
Additional Manufacturer Narrative
One heal collar 5.7x6.5, 5mm (hc565) was returned for investigation.Visual evaluation of the as returned products identified signs of use around the threads.However, one impl tapered scr-v ha 6mm 5.7mm 10mm (tsv6h10) was reported but not returned.Functional testing was performed using an applicable in-house implant.The device could not be threaded fully into the implant.Pre-existing condition noted in the per was moderate bone density ¿ type ii.The devices were intended for tooth #14.X-ray or picture images were not provided and no other information was provided.Appropriate documentation was reviewed.Dhr review for the lots (2021020367& 1244103) had revealed no deviations nor non-conformances which could have caused or contributed to the reported event.All products were conforming at the time they left zimmer biomet.Lots were inspected and passed all acceptance criteria by qa.Complaint history review was performed for the reported lot numbers (2021020367& 1244103) for similar events and no other complaint was identified.Based on the available information, healing collar malfunction did occur and the reported event was confirmed.
Event or Problem Description
No further event information available at the time of this report.

• Brand Name: HEAL COLLAR 5.7X6.5, 5MM
• Common Device Name: HEALING COLLAR
• Manufacturer (Section D): ZIMMER DENTAL; 4555 riverside drive; palm beach gardens FL 33410
• Manufacturer (Section G): ZIMMER DENTAL; 4555 riverside drive; palm beach gardens FL 33410
• Manufacturer Contact: susanne taylor ; 4555 riverside drive; palm beach gardens, FL 33410 ; 5617766700
• MDR Report Key: 12516585
• Report Number: 0002023141-2021-02644
• Device Sequence Number: 1139485
• Product Code: NHA
• UDI-Device Identifier: 00889024015128
• UDI-Public: (01)00889024015128(17)260208(10)2021020367
• Combination Product (Y/N): N
• Initial Reporter State: GA
• Initial Reporter Country: US
• PMA/510(K) Number: K111852
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Dentist
• Type of Report: Initial,Followup
• Report Date (Section B): 03/04/2022

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 Expiration Date: 02/08/2026
• Device Model Number: HC565
• Device Catalogue Number: HC565
• Device Lot Number: 2021020367
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/20/2021
• 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: 09/14/2021
• Supplement Date Received by Manufacturer: 03/04/2022
• Initial Report FDA Received Date: 09/22/2021
• Supplement Report FDA Received Date: 03/04/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 02/08/2021
• 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: Initial
• Patient Sequence Number: 1
• Patient Age: 49 YR
• Patient Sex: Male