MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional,user faci report with the FDA on 2020-03-06 for ABUTMENT TRI-GRIP FIXATION SCREW 1000-01B manufactured by Implant Direct Sybron Manufacturing Llc.
[182410966]
Per complaint (b)(4),the udi number on the product label was incorrect. This is an internal complaint, there was no patient involvement.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3001617766-2020-01903 |
| MDR Report Key | 9800306 |
| Report Source | HEALTH PROFESSIONAL,USER FACI |
| Date Received | 2020-03-06 |
| Date of Report | 2020-03-06 |
| Date Mfgr Received | 2020-02-12 |
| Device Manufacturer Date | 2017-05-12 |
| Date Added to Maude | 2020-03-06 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MRS ADRIENNE STOTT |
| Manufacturer Street | 3050 EAST HILLCREST DRIVE |
| Manufacturer City | THOUSAND OAKS, CA |
| Manufacturer Country | US |
| Manufacturer Phone | 4443300357 |
| Single Use | 3 |
| Remedial Action | IN |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ABUTMENT TRI-GRIP FIXATION SCREW |
| Generic Name | DENTAL IMPLANT |
| Product Code | NHA |
| Date Received | 2020-03-06 |
| Catalog Number | 1000-01B |
| Lot Number | 94673 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | IMPLANT DIRECT SYBRON MANUFACTURING LLC |
| Manufacturer Address | 3050 EAST HILLCREST DRIVE THOUSAND OAKS, CA US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2020-03-06 |