| Brand Name | EZTETIC DENTAL IMPLANT, 3.1MM DIAMETER, 2.9MMD PLATFORM, 13MM LENGTH |
| Common Device Name | DENTAL IMPLANT |
| 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 Key | 25415007 |
| Report Number | 0001038806-2026-03064 |
| Device Sequence Number | 9533304 |
| Product Code |
DZE
|
| UDI-Device Identifier | 00889024343894 |
| UDI-Public | (01)00889024343894(17)260831(10)1248314 |
| Combination Product (Y/N) | N |
| Initial Reporter State | NJ |
| Initial Reporter Country | US |
| 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 | 2026 |
| 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 |
| Report Date (Section B) |
06/05/2026 |
| 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 |
Lay User/Patient
|
| Device Expiration Date | 08/31/2026 |
| Device Catalogue Number | CT3113 |
| Device Lot Number | 1248314 |
| Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
| Date Returned to Manufacturer | 05/28/2026 |
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Initial |
| Initial Date Received by Manufacturer | Not provided |
| Initial Report FDA Received Date | 06/05/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 09/01/2021 |
| 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 | 57 YR |
| Patient Sex | Female |
| Patient Ethnicity | Non Hispanic |