| Brand Name | BRIDGE SCREW HEX |
| Common Device Name | IMPLANT, ENDOSSEOUS, ROOT-FORM |
| Manufacturer (Section D) |
| DENTSPLY IMPLANTS MANUFACTURING GMBH |
| rodenbacher chaussee 4 |
| hanau hessen 63457 |
| GM 63457 |
|
| Manufacturer (Section G) |
| DENTSPLY IMPLANTS MANUFACTURING GMBH |
| rodenbacher chaussee 4 |
|
| hanau hessen 63457 |
|
GM
63457
|
|
| Manufacturer Contact |
|
dan
eagar
|
| 221 west philadelphia st. |
| york, PA 17401
|
|
7178457511
|
|
| MDR Report Key | 24160249 |
| Report Number | 3013111692-2026-03377 |
| Device Sequence Number | 13043735 |
| Product Code |
DZE
|
| UDI-Device Identifier | 07392532001765 |
| UDI-Public | 07392532001765 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | CH |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2022 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,Company Representative |
| Initial Reporter Occupation |
Non-Healthcare Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
01/23/2026 |
| 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? |
Yes
|
| Operator of Device |
Health Professional
|
| Device Catalogue Number | 22435 |
| Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
| Date Returned to Manufacturer | 01/20/2026 |
| Distributor Facility Aware Date | 01/20/2026 |
| Type of Report(Section G) | Initial |
| Initial Date Received by Manufacturer | 01/20/2026 |
| Initial Report FDA Received Date | 01/23/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
Device Not Returned to Manufacturer
|
| 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 |
Concomitant Medical Products and Therapy/Usage Dates | NOT PROVIDED |
| Outcome Attributed to Adverse Event |
Required Intervention;
|
| Patient Sex | Unknown |