MAUDE Adverse Event Report: BIOMET 3I CERTAIN LOW PROFILE 17 ABUTMENT 3.4MM(D) X 4MM(H); DENTAL SCREW

Catalog Number	ILPAC3417
Medical Device Problem Code	Fracture (1260)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/04/2023
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Zimvie complaint number (b)(4).A4: patient weight unknown / not provided.
Event or Problem Description
It was reported that during a check up the doctor noticed that the abutment screws were fractured.Doctor cleaned up the area and replace the abutments.
Event or Problem Description
No further event information available at the time of this report.
Additional Manufacturer Narrative
Zimvie received one (1) ilpac3417, (certain® low profile 17° abutment 3.4mm(d) x 4mm(h)) for evaluation.Visual evaluation of the as returned device identified the abutment and its bundle screw with signs of use, wear.However, the screw was not fractured.Functional testing to recreate the reported event could not be performed due to the nature of the device & event.This complaint refers to the specific device being investigated for this complaint record.Dhr review was completed for the subject lot number 2022020266.No deviations or non-conformances, which could have caused or contributed to the reported event, were noted as part of the dhr.Complaint history review was performed for the reported lot number 2022020266 for similar events and no other complaint was identified.The customer did not submit images for the reported event.Documents reviewed: biomet 3i restorative products ifu (p-iis086gr) rev.G 2022/12.Information identified: "potential adverse events" page 2.Based on the investigation and risk management file review as per rmf rm-00057-haz rev.20, the most likely root causes determined from the investigation are missing or confusing instructions for use, clinician incorrectly engages abutment screw into implant, and torque applied during placement/ seating exceeds recommended value.However, the probable causes are not applicable to the reported event since the device malfunction did not occur and the event is unconfirmed through visual and physical inspection.Therefore, based on the available information, a device malfunction did not occur.The reported event was unconfirmed with all the available information.No further investigation or immediate capa / hhe/d escalation is required, as the complaint investigation did not confirm the product was nonconforming at the time of distribution, and no new failure mode, harm, or hazardous situation was identified through the investigation performed.At this time, the complaint investigation has been completed and the record will be closed.If additional information is received, the record will be re-opened for further evaluation.The following sections have been updated: b4: date of this report.G3: date received by manufacturer.G6: checked "follow-up".H2: checked follow-up type.H3: changed "no" to "yes".

• Brand Name: CERTAIN LOW PROFILE 17 ABUTMENT 3.4MM(D) X 4MM(H)
• Common Device Name: DENTAL SCREW
• 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 ; 5619713230
• MDR Report Key: 17446224
• Report Number: 0001038806-2023-01455
• Device Sequence Number: 11440952
• Product Code: NHA
• UDI-Device Identifier: 00844868037545
• UDI-Public: (01)00844868037545(17)270223(10)2022020266
• Combination Product (Y/N): N
• Initial Reporter Country: FR
• PMA/510(K) Number: K092341
• Exemption Number: 5645646
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Distributor
• Initial Reporter Occupation: Dentist
• Type of Report: Initial,Followup
• Report Date (Section B): 01/22/2024

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: Lay User/Patient
• Device Catalogue Number: ILPAC3417
• Device Lot Number: 2022020266
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/16/2023
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: Not provided
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 08/02/2023
• Supplement Report FDA Received Date: 01/23/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 02/22/2022
• 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): Yes
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Age: 67 YR
• Patient Sex: Female
• Patient Ethnicity: Non Hispanic