MAUDE Adverse Event Report: BIOMET 3I 3I T3® SHORT EXTERNAL HEX PARALLEL WALLED IMPLANT WITH DCD®, 6MM(D) X 5MM(L); DENTAL IMPLANT

Model Number	BNES605
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	No Information (3190)
Date of Event	11/27/2019
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
A summary investigation has been completed for lack of primary stability events that do not allege a deficiency with the implant and identified that the reported event is likely due to biological factors which have an adverse effect on implant stability or is related to surgical technique and insertion torque.Due to a wide range of external (non-design/non-manufacturing related), identifying a definitive root cause is generally not possible.Should additional information be received which indicates that the device may have caused or contributed to the event, an additional report will be submitted.Zimmer biomet complaint (b)(4).
Event or Problem Description
It was reported that an implant (bnes605) was unable to be placed into osteotomy.Implant did not achieve primary stability and it was removed.Tooth location 3.
Additional Manufacturer Narrative
Additional information received confirmed that this event has been previous captured and submitted under mfr 0001038806-2020-00135 on (b)(6) 2020.Upon a reassessment of this event, it has been determined this event as duplicate from (b)(4); as a result, this file will be closed.Additional follow up in regards this event will be submitted under mfr 0001038806-2020-00135.Therefore, no further medwatch reports will be submitted under this file.The following sections have been updated: b4: date of this report.G4: date received by manufacturer.G7: checked "follow-up".H2: checked follow-up type.H10: added manufacturer narrative.
Event or Problem Description
Additional information received confirmed that this event has been previous captured and submitted under mfr 0001038806-2020-00135.

• Brand Name: 3I T3® SHORT EXTERNAL HEX PARALLEL WALLED IMPLANT WITH DCD®, 6MM(D) X 5MM(L)
• Common Device Name: DENTAL IMPLANT
• Manufacturer (Section D): BIOMET 3I; 4555 riverside drive; palm beach gardens FL 33410
• MDR Report Key: 9587116
• Report Number: 0001038806-2020-00112
• Device Sequence Number: 17044936
• Product Code: DZE
• UDI-Device Identifier: 00844868033615
• UDI-Public: (01)00844868033615(17)230426(10)2018040712(241)BNES605
• Combination Product (Y/N): N
• Initial Reporter State: PR
• Initial Reporter Country: US
• PMA/510(K) Number: K150571
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2019
• Device Explanted Year: 2019
• Reporter Type: Manufacturer
• Report Source: health professional
• Initial Reporter Occupation: Dentist
• Type of Report: Initial,Followup
• Report Date (Section B): 01/27/2020

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 Expiration Date: 04/26/2023
• Device Model Number: BNES605
• Device Catalogue Number: BNES605
• Device Lot Number: 2018040712
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 12/16/2019
• Was the Report Sent to FDA?: No
• Initial Date Received by Manufacturer: 12/16/2019
• Supplement Date Received by Manufacturer: 01/17/2020
• Initial Report FDA Received Date: 01/14/2020
• Supplement Report FDA Received Date: 01/27/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 39 YR