MAUDE Adverse Event Report: ZIMMER DENTAL EZTETIC DENTAL IMPLANT, 3.1MM DIAMETER, 2.9MMD PLATFORM, 13MM LENGTH

Catalog Number	CT3113
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Nerve Damage (1979)
Date of Event	03/21/2021
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that implant was removed due to nerve injury.Loss integration.
Additional Manufacturer Narrative
Zimvie complaint number (b)(4).A4: patient weight unknown/not provided.E1: phone number (b)(6).
Additional Manufacturer Narrative
Zimvie received one (1) ct3113, (eztetic dental implant, 3.1mm diameter, 2.9mmd platform, 13mm length) for evaluation.Visual evaluation of the as returned device identified the implant with signs of use.No apparent damage / malfunction was identified with the implant that would cause or contribute to the reported events.Measurements match drawing.(b)(4) due: (b)(6) 2024.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 1230312.No deviations or non-conformances, which could have caused or contributed to the reported events, were noted as part of the dhr.Complaint history review was performed for the reported lot number 1230312 for similar events and no other complaint was identified.Review completed utilizing keywords: ¿loss of integration¿ & "medical other" the customer did submit one (1) image for the reported events.(see attachments tab at ce level) ifu review: documents reviewed: instructions for use ¿ implants, abutments and restorative components for 3.1mmd eztetic¿ implant - 9228 rev.1 ¿ 11/19.Information identified: "warnings".Based on the investigation and risk management file review as per rmf rm-00541-haz rev.4, the most likely root causes determined from the investigation are inadequate treatment planning, or patient factors - customer error.Therefore, based on the available information, a device malfunction did not occur.The reported events were non-verifiable 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.
Event or Problem Description
No further event information available at the time of this report.

• Brand Name: EZTETIC DENTAL IMPLANT, 3.1MM DIAMETER, 2.9MMD PLATFORM, 13MM LENGTH
• Common Device Name: DENTAL IMPLANT
• 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: carlos gordian-arroyo ; 4555 riverside drive; palm beach gardens, FL 33410 ; 5619713230
• MDR Report Key: 18870990
• Report Number: 0002023141-2024-00653
• Device Sequence Number: 7786123
• Product Code: DZE
• UDI-Device Identifier: 00889024343894
• UDI-Public: (01)00889024343894(17)240718(10)1230312
• Combination Product (Y/N): N
• Initial Reporter Country: TH
• PMA/510(K) Number: K142082
• Exemption Number: 5645646
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2021
• Device Explanted Year: 2023
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Distributor
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 08/11/2024

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
• Operator of Device: Lay User/Patient
• Device Catalogue Number: CT3113
• Device Lot Number: 1230312
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• 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: 03/08/2024
• Supplement Report FDA Received Date: 08/12/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 07/19/2019
• 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
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 52 YR
• Patient Sex: Male
• Patient Ethnicity: Non Hispanic