MAUDE Adverse Event Report: MIS Implants Technologies Ltd. C1 XD coni. con. implant D3.75 L8mm, SP; implant, endosseous, root-form

Catalog Number	C1-D08375
Medical Device Problem Code	Loss of Osseointegration (2408)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that a patient experienced a dental implant loss.There was no reported injury.
Additional Manufacturer Narrative
Since this event resulted in a serious injury, it is reportable per 21 cfr part 803.The device was not evaluated because the issue is a known inherent risk of the device.We will continue to track and monitor the trend.

• Brand Name: C1 XD coni. con. implant D3.75 L8mm, SP
• Common Device Name: implant, endosseous, root-form
• Manufacturer (Section D): MIS Implants Technologies Ltd.; p.o. box 7; 2015600 bar lev industrial; IS
• Manufacturer (Section G): MIS Implants Technologies Ltd.; p.o. box 7; 2015600 bar lev industrial par; IS
• Manufacturer Contact: dan eager ; 221 w. philadelphia st.; suite 60w; york, PA 17401 ; 1(717)845-7511
• MDR Report Key: 50773848
• Report Number: 3004203816-2026-25900
• Device Sequence Number: 10614574
• Product Code: DZE
• UDI-Device Identifier: 07290113996069
• UDI-Public: 07290113996069
• Combination Product (Y/N): N
• Initial Reporter Country: SF
• PMA/510(K) Number: K112162
• 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: Dentist
• Type of Report: Initial
• Report Date (Section B): 09/15/2026

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?: No
• Operator of Device: Health Professional
• Device Catalogue Number: C1-D08375
• Device Lot Number: W25007158
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/20/2026
• Initial Report FDA Received Date: 09/15/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• 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: Unknown
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention; Other
• Patient Sex: Unknown