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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ZIMVIE US CORP LLC CERTAIN GOLD-TITE TM HEXED SCREW; DENTAL SCREW

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ZIMVIE US CORP LLC CERTAIN GOLD-TITE TM HEXED SCREW; DENTAL SCREW Back to Search Results
Catalog Number IUNIHG
Medical Device Problem Code Fracture (1260)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 11/17/2025
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 screw fractured and the screw was removed.
 
Additional Manufacturer Narrative
Zimvie complaint number (b)(4).The following fields have been updated: b4: date of this report.B5: describe event or problem.D9: device availability product return no.G3: date received by manufacturer.G6: type of report.H1: type of reportable event.H2: follow up type.H3: device evaluated by manufacturer.H6: adverse event problem.H10: additional narrative.Zimvie did not receive one (1) iunihg, (certain gold-tite hexed screw) for evaluation.Visual inspection could not be performed.The investigation has been performed based on the available information using the item number, device history record (dhr) review, and risk management file (rmf).Dhr review was completed for the subject lot number 1279459.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 1279459 for similar events and no other complaint was identified.Review completed utilizing keywords: dental : functional : fracture : screw.Based on the investigation and risk management file review, the most likely root cause determined from the investigation was torque applied during placement/ seating exceeds recommended value.Therefore, based on the available information, a device malfunction could not be verified.Without device receipt, the reported event is non-verifiable.No further investigation or immediate capa / hhe/d escalation is required, as the complaint investigation did not confirm the products were 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 is available at the time of this report.
 
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Brand Name
CERTAIN GOLD-TITE TM HEXED SCREW
Common Device Name
DENTAL SCREW
Manufacturer (Section D)
ZIMVIE US CORP LLC
4555 riverside drive
palm beach gardens FL 33410
Manufacturer (Section G)
ZIMVIE US CORP LLC
4555 riverside drive
palm beach gardens FL 33410
Manufacturer Contact
mark  mashburn
4555 riverside drive
palm beach gardens, FL 33410
5619713230
MDR Report Key24018704
Report Number0001038806-2026-00155
Device Sequence Number15748843
Product Code NHA
UDI-Device Identifier00844868008538
UDI-Public(01)00844868008538(17)290410(10)1279459
Combination Product (Y/N)N
Initial Reporter CountryNL
PMA/510(K) Number
K072642
Exemption Number5645646
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)N
Reporter Type Manufacturer
Report Source Foreign,Health Professional
Initial Reporter Occupation Dentist
Type of Report Initial,Followup
Report Date (Section B) 02/10/2026
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 Other
Device Catalogue NumberIUNIHG
Device Lot Number1279459
Was Device Available for Evaluation? No
Date Returned to Manufacturer12/18/2025
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Follow-Up
Initial Date Received by Manufacturer Not provided
Supplement Date Received by ManufacturerNot provided
Initial Report FDA Received Date01/09/2026
Supplement Report FDA Received Date02/10/2026
Was Device Evaluated by Manufacturer? (Y/N) No
Date Device Manufactured04/11/2024
Is the Device Labeled for Single Use? (Y/N) No
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)
No
Usage of Device Unknown
Patient Sequence Number1
Patient Age60 YR
Patient SexUnknown
Patient EthnicityNon Hispanic
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