MAUDE Adverse Event Report: ALIGN TECHNOLOGY, INC. INVISALIGN SYSTEM; ALIGNER, SEQUENTIAL

Model Number INVISALIGN SYSTEM - LITE

Device Problem Appropriate Term/Code Not Available (3191)

Patient Problem Anaphylactic Shock (1703)

Event Date 09/20/2022

Event Type  Injury  

Event Description

The patient reported symptoms of an anaphylactic shock.The patient reported being hospitalized to alleviate the reported symptom.The patient did not report being prescribed any medical intervention to alleviate the reported symptom.The treatment was discontinued on (b)(6) 2022 and the patient is currently getting better.

Manufacturer Narrative

The current instructions for use (ifu) contains the following: "warning - in rare instances, some patient may be allergic to the plastic aligner material, discontinue use and consult a health care professional immediately." the potential root cause is unknown.No conclusive evidence has been provided that supports or opposes the fact that the invisalign aligners caused or contributed to the reported symptom.This event is being filed as an mdr as the patient reported an anaphylactic reaction and an invisalign product was being used.

• Brand Name: INVISALIGN SYSTEM
• Type of Device: ALIGNER, SEQUENTIAL
• Manufacturer (Section D): ALIGN TECHNOLOGY, INC.; 2820 orchard parkway; san jose CA 95134
• Manufacturer Contact: aaheli poddar ; 2820 orchard parkway; san jose, CA 95134 ; 4084701340
• MDR Report Key: 15621089
• MDR Text Key: 301910376
• Report Number: 2953749-2022-03392
• Device Sequence Number: 1
• Product Code: NXC
• UDI-Device Identifier: 00816063020202
• UDI-Public: (01)00816063020202(10)0126994342(13)220823(91)1804031401N
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K220287
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date: 10/17/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/18/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Lay User/Patient
• Device Model Number: INVISALIGN SYSTEM - LITE
• Device Catalogue Number: 8844
• Device Lot Number: 126994342
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 10/07/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 08/23/2022
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Hospitalization; Other
• Patient Age: 17 YR
• Patient Sex: Female