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 | 16726962 |
MDR Text Key | 313158851 |
Report Number | 2027971-2023-062979 |
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 |