| Brand Name | NobelActive Internal RP 4.3x11.5mm |
| Common Device Name | Endosseous Dental Implant |
| Manufacturer (Section D) |
| Nobel Biocare AB |
| dimbovägen 2 |
| karlskoga 69151 |
| SW 69151 |
|
| MDR Report Key | 50743639 |
| Report Number | 2027971-2026-127095 |
| Device Sequence Number | 12977244 |
| Product Code |
DZE
|
| UDI-Device Identifier | 07332747010633 |
| UDI-Public | (01)07332747010633(10)12117779(17)230811 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | MX |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2018 |
| Device Explanted Year | 2026 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Importer
|
| Initial Reporter Occupation |
Dentist
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/11/2026 |
| Report Date (Section F) |
09/11/2026 |
| 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
|
| Operator of Device |
Health Professional
|
| Device Expiration Date | 08/11/2023 |
| Device Catalogue Number | 34132 |
| Device Lot Number | 12117779 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
Yes
|
| Was the Report Sent to FDA? |
No
|
| Distributor Facility Aware Date | 09/03/2026 |
| Event Location |
Outpatient Treatment Facility
|
| Initial Date Received by Manufacturer | Not provided |
| Initial Report FDA Received Date | 09/11/2026 |
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Patient Sequence Number | 1 |
| Outcome Attributed to Adverse Event |
Required Intervention;
|
| Patient Age | 74 YR |
| Patient Sex | Female |