| Brand Name | CERTAIN® 3.4MM(D) DRIVER TIP - SHORT |
| Common Device Name | DENTAL DRIVER |
| 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 | 25688225 |
| Report Number | 0001038806-2026-03421 |
| Device Sequence Number | 11923239 |
| Product Code |
NDP
|
| UDI-Device Identifier | 00844868006473 |
| UDI-Public | (01)00844868006473(10)1209655 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | IT |
| PMA/510(K) Number | EXEMPT |
| Exemption Number | 5645646 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| 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 |
| Report Date (Section B) |
07/02/2026 |
| 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 |
Health Professional
|
| Device Catalogue Number | IMPDTS |
| Device Lot Number | 1209655 |
| Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
| Date Returned to Manufacturer | 06/10/2026 |
| 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 | 07/02/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 10/13/2017 |
| 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 Number | 1 |
| Patient Sex | Unknown |
| Patient Ethnicity | Non Hispanic |