MAUDE MDR 6947632

MDR report key
6947632
Report number
3002924436-2017-00015
Event key
0
Event type
3
Date of event
2018-07-01
Date received
2017-10-13
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
0
Initial report to FDA
0
Event location
3

Manufacturer Contact#

Contact
MS CHARITY EMMONS
Address
11621 RESEARCH CIRCLE ALACHUA FL 32615 US
Phone
386-386-3864
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1COPIOS PERICARDIUM XENOGRAFT MEMBRANECOPIOS PERICARDIUM XENOGRAFT MEMBRANETUTOGEN MEDICAL GMBHNPLNZ16200121N N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12017-10-1301. O

Event Narratives#

N

Patient 1

RTI/TMI WILL CONDUCT A RE-REVIEW OF THE PRODUCT HISTORY RECORD FOR COPIOS PERICARDIUM MEMBRANES, PACKAGING PRODUCTION RECORDS, ENVIRONMENTAL MONITORING, DISTRIBUTION FOR RELATED COMPLAINTS ASSOCIATED TO THE LOT. RESULTS: PENDING. CONCLUSION: PENDING. A FOLLOW-UP MED WATCH WILL BE SUBMITTED.

D

Patient 1

ON SEPTEMBER 7, 2017 (B)(6) OF ZIMMER BIOMET INFORMED TUTOGEN ABOUT THIS COMPLAINT FROM AN UNKNOWN DENTIST. THE DENTIST REPORTED ABOUT A CASE IN WHICH THE ABOVE PRODUCTS WERE IMPLANTED IN A SINUS LIFT PROCEDURE ON (B)(6) 2017. DOCTOR INDICATED A SINUS LIFT WAS PERFORMED (WITH A W INDO W APPROACH) . BONE GRAFT, MEMBRANE AND TWO DENTAL IMPLANTS WERE PLACED IN THE SAME DAY ON TOOTH LOCATION 16 AND 17. PATIENT CAME TO THE DENTIST DURING THE FIRST WEEK AFTER PLACEMENT FOR A CHECKUP COMPLAINING ABO UT PAIN. ANTIBIOTICS HAD BEEN PREVIOUSLY PRESCRIBED AFTER THE SURGERY. THE DENTIST DECIDED TO EXTEND THE SAME ANTIBIOTIC TREATMENT. DURING THE SECOND WEEK, THE PATIENT HAD PRESSURE IN THE AREA AND SEVERE PAIN . THE DENT IST REALIZED THAT THERE WERE AN EDEMA AND A DISTAL VESTIBULAR FISTULA ON DENTAL SIT E 17. A SLIGHT CURETTAGE WAS PERFORMED. IT WAS SUSPECTED THAT THERE WAS A SEVERE INFECTION COMING FROM THE BIO-MATERIAL. DURING THE THIRD WEEK, THE PAIN CONTINUED. THUS, IT WAS DECIDED TO REMOVE ALL THE BIO? MATERIAL. THE IMPLANT IN DENTAL SITE 17 WAS PARTIALLY PLACED INTO THE GRAFTED AREA. THEREFORE, THE DENTIST REMOVED THE TWO IMPLANTS AS A PRECAUTION AS WE LL. THE DENTIST CLOSED THE WOUND AND WOULD WAIT UNTIL THE PATIENT'S BONE REGENERATE BY ITSELF TO PERFORM A NEW SINUS LIFT AND NEW PLACEMENT IN THE NEAR FUTURE ((B)(6) 2017). IN PRINCIPLE, INFECTION COULD HAVE BEEN CAUSED BY NON-STERILE PRODUCTS OR IATROGENIC FACTORS. IN ORDER TO VERIFY THAT THE ABOVE MENTIONED PRODUCTS ARE NOT CAUSATIVE, BATCH DOCUMENTATION WILL BE REVIEWED.