MAUDE Adverse Event Report: BIOMET 3I OSSEOTITE TAPERED CERTAIN PREVAIL IMPLANT 6/5 X 11.5 MM; DENTAL IMPLANT

Catalog Number	XIITP6511
Medical Device Problem Code	Mechanical Problem (1384)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/03/2023
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Zimvie complaint number (b)(4).
Event or Problem Description
It was reported driver used for delivery of implant insecure.Unable to lock in successfully place and torque implant.Tooth 30.It was also reported that the issue was with the implant, not the driver.Was able to complete procedure with another implant.Driver will not be returning.
Additional Manufacturer Narrative
Zimvie received one (1) xiitp6511, (osseotite® tapered certain® prevail® implant 6/5 x 11.5 mm) for evaluation.Visual evaluation of the as returned device identified the implant with signs of use, slight wear however, no malfunction.Engaged with an in-house driver as intended, during a functional test.This complaint refers to the specific device being investigated for this complaint record.Dhr review was completed for the subject lot number 2022100914.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 2022100914 for similar events and no other complaint was identified.Review completed utilizing keywords: ¿does not assemble¿ the customer did not submit images for the reported event.Ifu review: documents reviewed: biomet 3i dental implant ifu p-iis086gi rev.J 2022/08.Information identified: "warnings" "contraindications" "precautions" based on the investigation and risk management file review as per rmf rm-00053-haz rev.12, the most likely root causes determined from the investigation are customer error ¿ improper techniques used.Therefore, based on the available information, the implant malfunction did not occur.The reported event was non-verifiable with all the available information, and without return of all devices involved.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.
Event or Problem Description
No further event information available at the time of this report.

• Brand Name: OSSEOTITE TAPERED CERTAIN PREVAIL IMPLANT 6/5 X 11.5 MM
• Common Device Name: DENTAL IMPLANT
• 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: carlos gordian-arroyo ; 4555 riverside drive; palm beach gardens, FL 33410 ; 5619713230
• MDR Report Key: 18256712
• Report Number: 0001038806-2023-02348
• Device Sequence Number: 6571749
• Product Code: DZE
• UDI-Device Identifier: 00844868022213
• UDI-Public: (01)00844868022213(17)271109(10)2022100914
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: K130949
• Exemption Number: 5645646
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2023
• Device Explanted Year: 2023
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional,User Facility
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 04/16/2024

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: Health Professional
• Device Catalogue Number: XIITP6511
• Device Lot Number: 2022100914
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 10/09/2023
• 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: 12/04/2023
• Supplement Report FDA Received Date: 04/17/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 11/08/2022
• 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): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Age: 48 YR
• Patient Sex: Female
• Patient Ethnicity: Non Hispanic