| Brand Name | SEVEN XD int. hex. implant D4.2 L10mm SP |
| Common Device Name | implant, endosseous, root-form |
| Manufacturer (Section D) |
| MIS Implants Technologies Ltd. |
| p.o. box 7 |
| bar lev industrial park 20156 00 |
| IS 2015600 |
|
| Manufacturer (Section G) |
| MIS Implants Technologies Ltd. |
| p.o. box 7 |
|
| bar lev industrial park 20156 00 |
|
IS
2015600
|
|
| Manufacturer Contact |
|
dan
eagar
|
| 221 w. philadelphia st. |
| suite 60w |
| york, PA 17401
|
|
+1(717)845-7511
|
|
| MDR Report Key | 50790405 |
| Report Number | 3004203816-2026-26055 |
| Device Sequence Number | 21475452 |
| Product Code |
DZE
|
| UDI-Device Identifier | 07290113997738 |
| UDI-Public | 07290113997738 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | MX |
| PMA/510(K) Number | K180282 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,Health Professional,Distributor |
| Initial Reporter Occupation |
Non-Healthcare Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/16/2026 |
| 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 |
Other
|
| Device Catalogue Number | MF7-D10420 |
| Device Lot Number | W25004121 |
| Was Device Available for Evaluation? |
Yes
|
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 08/21/2026 |
| Initial Report FDA Received Date | 09/16/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Initial
|
| Patient Sequence Number | 1 |
| Outcome Attributed to Adverse Event |
Required Intervention;
|
| Patient Age | 50 YR |
| Patient Sex | Male |