Brand Name | LEGACY OVERDENTURE ABUTMENT |
Type of Device | DENTAL IMPLANT |
Manufacturer (Section D) |
IMPLANT DIRECT SYBRON MANUFACTURING LLC |
3050 east hillcrest drive |
thousand oaks CA 91362 |
|
Manufacturer Contact |
marcos
gutierrez
|
3050 east hillcrest drive |
thousand oaks, CA 91362
|
8184443315
|
|
MDR Report Key | 15456559 |
MDR Text Key | 300252996 |
Report Number | 3001617766-2022-04565 |
Device Sequence Number | 1 |
Product Code |
NHA
|
UDI-Device Identifier | 10841307111498 |
UDI-Public | 10841307111498 |
Combination Product (y/n) | N |
Reporter Country Code | JA |
PMA/PMN Number | K090234 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Health Professional,Distributor |
Reporter Occupation |
Non-Healthcare Professional
|
Remedial Action |
Inspection |
Type of Report
| Initial |
Report Date |
06/08/2022 |
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
|
Device Operator |
Health Professional
|
Device Expiration Date | 01/23/2024 |
Device Catalogue Number | 8035-62 |
Device Lot Number | 132197 |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
08/31/2022 |
Initial Date FDA Received | 09/20/2022 |
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 01/24/2019 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 63 YR |
Patient Sex | Female |
|
|