MAUDE Adverse Event Report: BIOMET 3I FULL OSSEOTITE IMPLANT 4 X 13MM; DENTAL IMPLANT

Model Number	FOS413
Medical Device Problem Code	Fracture (1260)
Health Effect - Clinical Code	Pain (1994)
Date of Event	12/29/2014
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Zimmerbiomet complaint number (b)(4).Initial reporter last name unknown / not provided.
Event or Problem Description
It was reported that implant fractured and was removed.Symptoms as a result of the event: pain.
Additional Manufacturer Narrative
Zimmerbiomet complaint number (b)(4).The full osseotite® implant 4 x 13mm (fos413) was not returned.Since product has not been returned, visual/functional inspection could not be performed.The investigation has been performed based on the available information.It is noted on the per that the patient has a history of clenching, which can contribute to implant fracture.The reported product was located on tooth # 23 (fdi) and used for an un-verified period of time based on the information provided.The reported event could not be recreated due to the nature of the dental device and event (fracture).The customer has not provided additional pictures or x-ray images of the product.Dhr review was completed for the subject lot number 2014051122.It was confirmed that all operations and inspections were executed as per applicable procedure.No deviations or non-conformances, which could have caused or contributed to the reported event was noted as part of the dhr.Lot was inspected and passed all acceptance criteria by qa.Complaint history review was performed for the reported lot number (2014051122) for similar event and no other complaint was identified.April post market trending was reviewed and there were no actionable events or corrective actions for the reported event (implant fracture) or product (fos413).Therefore, based on the available information, device malfunction could not be verified and the reported event was non-verifiable.The following sections have been updated: h3: device evaluated by manufacturer: change ¿no' to 'yes.'.
Event or Problem Description
No further event information is available at the time of this report.
Additional Manufacturer Narrative
Zimmerbiomet complaint number: (b)(4).One full osseotite® implant 4 x 13mm (fos413) was returned for inspection.Visual evaluation of the returned device notes that the implant is covered in a moderate amount of bone at the threads, and fractured at the collar into two pieces.It is noted on the per that the patient has a history of clenching, which can contribute to implant fracture.The reported product was located on tooth # 23 (fdi) and used for an un-verified period of time based on the information provided.The reported event could not be recreated due to the nature of the dental device and event (fracture).The customer has not provided additional pictures or x-ray images of the product.Dhr review was completed for the subject lot number 2014051122.It was confirmed that all operations and inspections were executed as per applicable procedure.No deviations or non-conformances, which could have caused or contributed to the reported event was noted as part of the dhr.Lot was inspected and passed all acceptance criteria by qa.Complaint history review was performed for the reported lot number (2014051122) for similar event and no other complaint was identified.May post market trending was reviewed and there were no actionable events or corrective actions for the reported event (implant fracture) or product (fos413).Therefore, based on the available information, device malfunction has occurred and the reported event was confirmed.
Event or Problem Description
No further event information is available at the time of this report.

• Brand Name: FULL OSSEOTITE IMPLANT 4 X 13MM
• Common Device Name: DENTAL IMPLANT
• Manufacturer (Section D): BIOMET 3I; 4555 riverside drive; palm beach gardens FL 33410
• MDR Report Key: 9878370
• Report Number: 0001038806-2020-00570
• Device Sequence Number: 18973051
• Product Code: DZE
• UDI-Device Identifier: 00844868003625
• UDI-Public: (01)00844868003625(17)190527(10)2014051122(241)FOS413
• Combination Product (Y/N): N
• PMA/510(K) Number: K063286
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2014
• Device Explanted Year: 2014
• Reporter Type: Manufacturer
• Report Source: foreign,health professional
• Initial Reporter Occupation: Dentist
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 07/31/2020

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?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 05/27/2019
• Device Model Number: FOS413
• Device Catalogue Number: FOS413
• Device Lot Number: 2014051122
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/09/2020
• Was the Report Sent to FDA?: No
• Initial Date Received by Manufacturer: 03/09/2020
• Supplement Date Received by Manufacturer: 06/12/2020; 07/28/2020
• Initial Report FDA Received Date: 03/25/2020
• Supplement Report FDA Received Date: 06/25/2020; 07/31/2020
• 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: 74 YR
• Patient Weight: 72