MAUDE Adverse Event Report: NOBEL BIOCARE AB NOBELACTIVE TIULTRA WP 5.5X11.5MM; ENDOSSEOUS DENTAL IMPLANT

Model Number 300265

Device Problem Defective Device (2588)

Patient Problem Failure of Implant (1924)

Event Date 03/24/2023

Event Type  Injury  

Event Description

Implant failed due to part not functional.

• Brand Name: NOBELACTIVE TIULTRA WP 5.5X11.5MM
• Type of Device: ENDOSSEOUS DENTAL IMPLANT
• Manufacturer (Section D): NOBEL BIOCARE AB; dimbovägen 2; karlskoga 69151 ; SW 69151
• MDR Report Key: 16726866
• MDR Text Key: 313158209
• Report Number: 2027971-2023-062981
• Device Sequence Number: 1
• Product Code: DZE
• UDI-Device Identifier: 07332747127560
• UDI-Public: (01)07332747127560(10)12202743(17)270526
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Distributor
• Reporter Occupation: Dentist
• Type of Report: Initial
• Report Date: 04/12/2023

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
• Device Operator: Health Professional
• Device Model Number: 300265
• Device Catalogue Number: 300265
• Device Lot Number: 12202743
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Date Report Sent to FDA: 04/12/2023
• Distributor Facility Aware Date: 03/28/2023
• Event Location: Outpatient Treatment Facility
• Initial Date Manufacturer Received: Not provided
• Initial Date FDA Received: 04/12/2023
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: A
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 62 YR
• Patient Sex: Female